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Background: In the last years, there has been an increase in publication of systematic reviews of normative ("argument-based") literature or of normative information (such as ethical issues) in bioethics. The aim of a systematic review is to search, select, analyse and synthesise literature in a transparent and systematic way in order to provide a comprehensive and unbiased overview of the information sought, predominantly as a basis for informed decision-making in health care. Traditionally, one part of the procedure when conducting a systematic review is an appraisal of the quality of the literature that could be included.Main Text: However, while there are established methods and standards for appraising e.g. clinical studies or other empirical research, quality appraisal of normative literature (or normative information) in the context of a systematic review is still rather a conundrum - not only is it unclear how it could or should be done, but also the question whether it necessarily must be done is not settled yet. Based on a pragmatic definition of "normative literature" as well as on a typology of different types of systematic reviews of normative literature/information, this paper identifies and critically discusses three possible strategies of conducting quality appraisal.Conclusions: The paper will argue that none of the three strategies is able to provide a general and satisfying solution to the problems associated with quality appraisal of normative literature/information. Still, the discussion of the three strategies allows outlining minimal conditions that elaborated strategies have to meet in future, and facilitates sketching a theoretically and practically promising strategy. [ABSTRACT FROM AUTHOR]

Since James Thomson of the University of Wisconsin, Madison, first isolated human embryonic stem cells in 1998, controversies over research with these cells have erupted in many countries, and sometimes died down again. Most nations have regulated research with these cells, whose production requires the ethically controversial destruction of human embryos. Germany, after a broad public debate, voted to pass a law that prohibits the production of new stem cell lines, but permits their importation under strictly defined circumstances. This law effectively ended the public debate. Drawing on ethnographic work and interviews with scientists and ethicists, this paper analyses the implementation of the 2002 Stem Cell Law and its consequences for stem cell research in Germany. The paper argues that, as a highly charged political debate transformed into administrative routine, the concepts used in the debate underwent shifts in meaning. The division of labour between the two institutions charged with evaluating the research proposals inverted 'scientific' and 'ethical' criteria such that doing stem cell research 'ethically' came to mean doing stem cell research 'scientifically'. The foundational ethical questions debated in society were thus transformed into enabling rules of scientific practice. The paper further argues that these shifts reveal culturally specific responses to the emergence of new forms of life. [ABSTRACT FROM AUTHOR]

Egg freezing has led to heated debates in healthcare policy and bioethics. A crucial issue in this context concerns the distinction between "medical" and "social" egg freezing (MEF and SEF)—contrasting objections to bio-medicalization with claims for oversimplification. Yet such categorization remains a criterion for regulation. This paper aims to explore the "regulatory boundary-work" around the "medical"–"social" distinction in different egg freezing regulations. Based on systematic documents' analysis we present a cross-national comparison of the way the "medical"–"social" differentiation finds expression in regulatory frameworks in Austria, Germany, Israel, and the Netherlands. Findings are organized along two emerging themes: (1) the definition of MEF and its distinctiveness—highlighting regulatory differences in the clarity of the definition and in the medical indications used for creating it (less clear in Austria and Germany, detailed in Israel and the Netherlands); and (2) hierarchy of medical over social motivations reflected in usage and funding regulations. Blurred demarcation lines between "medical" and "social" are further discussed as representing a paradoxical inclusion of SEF while offering new insights into the complexity and normativity of this distinction. Finally, we draw conclusions for policymaking and the bioethical debate, also concerning the related cryopolitical aspects. [ABSTRACT FROM AUTHOR]

On 20 August 1947, the United States Military Tribunal condemned sixteen persons in Nuremberg for crimes committed in the name of science in several concentration camps. Moving away from a dichotomous stance delineating true science/false science, the judges were able to outline ten ethical and legal principles to regulate all clinical experiments, which were subsequently known as the Nuremberg Code. Where most of legal commentaries focus on the mere reading of these ten principles, this paper will highlight some of the steps in the legal journey of the American judges. We will see that, unfortunately, they failed to address one of the most difficult issues in clinical trials and human experimentation: the almost unavoidable context of exploitation of any situation where a person is used as an object for the good of others. [ABSTRACT FROM AUTHOR]

The paper provides a critical commentary on the article by Baker and McCullough on Medical Ethic's Appropriation of Moral Philosophy. The author argues that Baker and McCullough offer a more "pragmatic" approach to the history of medical ethics that has the potential to enrich the bioethics field with a greater historical grounding and sound methodology. Their approach can help us to come to a more nuanced understanding about the way in which medical ethics has connected, disconnected, and reconnected with philosophical ideas throughout the centuries. The author points out that Baker and McCullough's model can run the danger of overemphasizing the role of medical ethicists whilst marginalizing the influence of philosophers and of other historical actors and forces. He critically reviews the two case studies on which Baker and McCullough focus and concludes that scholars need to bear in mind the levels of uncertainty and ambivalence that accompany the process of transformation and dissemination of moral values in medicine and medical practice.

Philosophy textbooks typically treat bioethics as a form of "applied ethics"-i.e., an attempt to apply a moral theory, like utilitarianism, to controversial ethical issues in biology and medicine. Historians, however, can find virtually no cases in which applied philosophical moral theory influenced ethical practice in biology or medicine. In light of the absence of historical evidence, the authors of this paper advance an alternative model of the historical relationship between philosophical ethics and medical ethics, the appropriation model. They offer two historical case studies to illustrate the ways in which physicians have "appropriated" concepts and theory fragments from philosophers, and demonstrate how appropriated moral philosophy profoundly influenced the way medical morality was conceived and practiced.

This essay roughly sketches two major conceptions of autonomy in contemporary bioethics that promote the resourcification of human body parts: (1) a narrow conception of autonomy as self-determination; and (2) the conception of autonomy as dissociated from human dignity. In this paper I will argue that, on the one hand, these two conceptions are very different from that found in the modern European tradition of philosophical inquiry, because bioethics has concentrated on an external account of patient's self-determination and on dissociating dignity from internal human nature. However, on the other hand, they are consistent with more recent European philosophy. In this more recent tradition, human dignity has gradually been dissociated from contextual values, and human subjectivity has been dissociated from objectivity and absolutized as never to be objectified. In the concluding part, I will give a speculative sketch in which Kant's internal inquiry of maxim of ends, causality and end, and dignity as iirreplaceability is recombined with bioethics' externalized one and used to support an extended human resourcification.

As elsewhere, the ethical debate on embryonic stem cell research in Central Europe, especially Germany and Switzerland, involves controversy over the status of the human embryo. There is a distinctive Kantian flavor to the standard arguments however, and we show how they often embody a set of misunderstandings and argumentative shortcuts we term"embryological Kantianism."We also undertake a broader analysis of three arguments typically presented in this debate, especially in official position papers, namely the identity, continuity, and potentiality arguments. It turns out that these arguments do not support the strong, quasi-personal status accorded to the embryos in these official opinions.

In Germany the public awareness on ethical problems of the application of medicine and life sciences on human beings is very high. It can be observed that German Society is rather sensitive concerning bioethical issues. Politics supports this attitude. Many articles in professional journals as well as in newspapers cover bioethical issues. Conferences and workshops on a professional and an educational level deal with topics on ethics of life sciences and ethics in general. Moreover, in the case of bioethics many different disciplines contribute with relevant considerations to the process of opinion and judgment formation. This paper summarizes the main ethical and legal debates on bioethical issues in Germany, specifies the focus of leading German centres of bioethics and biolaw, and explains the tasks, services and networking of the German Reference Centre for Ethics in the Life Sciences (DRZE) which was founded by the Federal Government.

Can the bioethical theories that have served American bioethics so well, serve international bioethics as well? In two papers in the previous issue of the Kennedy Institute of Ethics Journal, I contend that the form of principlist fundamentalism endorsed by American bioethicists like Tom Beauchamp and Ruth Macklin will not play on an international stage. Deploying techniques of postmodern scholarship, I argue that principlist fundamentalism justifies neither the condemnation of the Nazi doctors at Nuremberg, nor, as the Report of the Advisory Committee on the Human Radiation Experiments (ACHRE) demonstrates, condemnation of Cold War radiation researchers. Principlist fundamentalism thus appears to be philosophy bankrupt. In this issue of the Journal, Beauchamp and Macklin reject this claim, arguing that I have misread the ACHRE report and misunderstood Nazism. They also argue that the form of post-postmodern negotiated human rights theory that I proffer is adequate only insofar as it is itself really fundamentalist; insofar as I take postmodernism seriously, however, I mire international bioethics in relativism. In this response, I reaffirm my anti-fundamentalism, provide further evidence in support of my reading of the ACHRE report, and defend my post-postmodern version of rights theory. I also develop criteria for a minimally adequate theoretical framework for international bioethics.

In the debate regarding the different possibilities for gene therapy, it is presupposed that the manipulations are limited to the nuclear genome (nDNA). Given recent advances in genetics, mitochondrial genome (mtDNA) and diseases must be considered as well. In this paper, we propose a three dimensional framework for the ethical debate of gene therapy where we add the genomic type (nDNA vs. mtDNA) as a third dimension to be considered beside the paradigmatic dimensions of target cell (somatic vs. germ-line) and purpose (therapeutic vs. enhancement). Somatic gene therapy can be viewed today as generally accepted, and we review the contemporary arguments surrounding it on the basis of bioethical-pragmatic, socio-political and deontological classifications. Many of the supposed ethical questions of somatic gene therapy today are not new; they are well-known issues of research ethics. We also critically summarize the different international perspectives and the German ethical discussion regarding manipulations of germ-line cells.

Progress in medicine has solved many problems facing humanity. At the same time, however, it has also led to many new ones. There is no reason to believe that this ambivalence will cease to exist with respect to future applications of gene technology in medicine. A sober and differential assessment of the chances and risks of this new technology is therefore necessary. The present paper outlines just such an assessment. Its main conclusion is that genetic diagnostics may pose more difficult ethical and social problems than gene therapy. This may especially be the case if this diagnostic technology is routinely used for screening programs to detect widespread diseases like cancer, hypertension or diabetes in a population that is not at high risk.

Non-human animals are commonly classified according to their "role", such as "livestock", "wild" or "companion" animals. But what if those classifications overlap? This article presents a report of the retreat week "ZooCan – Zoonoses of companion animals as case study for animal ethics" at the University of Veterinary Medicine Hannover, Germany, in November 2022. The workshop included participants from different European countries with interdisciplinary backgrounds (animal law, bioethics, epidemiology, philosophy, biology and veterinary medicine). We address ethically relevant issues that emerge when companion animals are used as research animals, particularly in zoonoses research. The outcomes of the multi-disciplinary approach are used to i) define criteria to classify "companion" and "research" animals, ii) provide guidance to overcome the challenges with classificational overlaps, iii) give insights into cutting-edge zoonoses research with an example of SARS-CoV-2 in cats, and iv) discuss animal ethics approaches with regard to classifications. [ABSTRACT FROM AUTHOR]

Philosophy has a complicated relationship with nursing practice. Selected concepts from Hans‐Georg Gadamer's Truth and Method specifically prejudice, conversation, and language are articulated. An exemplar involving nursing practice at an outpatient clinic for women seeking pre‐ and postbreast cancer care is offered to explicate these concepts. We considered the fit of Gadamer's philosophy, particularly the concept of conversation, within a public health nursing practice context in home and community settings of the client/family and offered tentative conclusions. To extend the discussion of the relationship between philosophy and nursing practice, we posed questions developed to provide deeper insight into this complicated relationship. [ABSTRACT FROM AUTHOR]

Background: Bioethics can play an important role in addressing diversity both in and outside of academia, setting precedents for meaningful contributions to public discourse, research, teaching, training, and policy development. However, in order to do so, these conversations also need to reflect on the issue of diversity within the field of bioethics across the globe. This study aims to examine current gender representation and diversity at medical ethics and humanities institutes in Germany, the German-speaking areas of Switzerland, and Austria. Methods: A total of forty-nine medical ethics and humanities institutes from Germany (n=42), the German-speaking areas of Switzerland (n=5), and Austria (n=2) were included in the study. Institutes websites were reviewed in the first week of March 2021 and the details of each staff member listed on the website recorded. Results: Overall, a total of 964 staff members were identified at the forty-nine German-speaking medical ethics and humanities institutes. Just over half (530/964; 55%) of all staff were female. There were significant differences between gender in some staff positions: 64.6 per cent (31/48) of directors were male (χ2(1)=4.1, P=.04); 62.7 per cent (84/134) of student assistants were female (χ2(1)=8.6, P=.003); and 83.7 per cent (77/92) of administrative staff were female (χ2(1)=41.8, P<.001). There were no significant differences between staff gender for researchers and lecturers, or associated researchers. In addition, 65.5 per cent (19/29) of researchers and lecturers who had a professor title were male, but the difference between genders was not found to be significant. However, significantly more of the researchers and lecturers who had completed a habilitation were male (75.8% (25/33); χ2(1)=8.8, P=.003). When comparing the institute director's gender presentation with staff gender presentation, it was found that male-led institutes had 53.4 per cent (286/536) female staff overall but had 52.7 per cent (136/258) male researchers and lecturers. However, the difference between genders were not found to be significant. On the other hand, female-led institutes had significantly more female staff overall (59.9% (223/372); χ2(1)=14.7, P<.001) and also significantly more female researchers and lecturers (58.9% (119/202; χ2(1)=6.4, P=.01). Conclusions: There has been a significant push to address gender diversity in German-speaking academia, and this study finds overall good gender parity in medical ethics and humanities institutes. However, there has not been a similar openness to discussing issues of systemic racism or how other forms of inequality affect academic diversity. Taking diversity seriously requires opening up conversations around intersectionality, including difficult conversations around race and cultural background that have long been taboo in German-speaking countries. [ABSTRACT FROM AUTHOR]

Since its inception in the late 1960s and early 1970s, the academic discipline of bioethics has profoundly shaped the professional and public assessments of biomedicine. A universalistic approach preferred by American bioethicists and challenges posed by modern biomedicine created a transatlantic moment for ethical theories and practices. This article will discuss the transfer of bioethical knowledge from the United States to (West) Germany and highlight its immediate reception, its slow adaptation, and its belated implementation at universities, in society, and in the medical profession. Examples from academia, policy and law will provide a narrative focus for explaining the peculiar relationship between institutional ambitions, universalistic theoretical claims, and local professional routines and adjustments. In particular, the article contrasts a general openness towards ethical concepts and practices with the comparably reluctance in adopting American bioethics as it was perceived in Germany, which effectively delayed the implementation of ethics in German medicine for decades. The German responses to American bioethics provide a topical example for boundary work on an international level. [ABSTRACT FROM AUTHOR]

While the argument of complicity is only rarely discussed in bioethics, it is of obvious relevance to the issue of imported embryonic stem cells in countries in which the derivation of stem cells from early human embryos is legally prohibited and/or morally rejected. Complicity means that making use of the results or products of an illegal or morally problematic activity is itself morally problematic, although generally to a lesser degree than the original activity. The question arises as to which conditions make the argument of complicity plausible, thus supporting attacks against legislation that aims to promote research based on 'fruits of a forbidden tree'. This paper distinguishes a number of different variants of complicity, proposes that they deserve different kinds of moral valuation and applies the results to the ongoing debate about the German stem cell research law. [ABSTRACT FROM AUTHOR]

New assisted reproduction technologies provide access to, and require the handling of, genetic material. Such material includes gametes or early-stage embryos. After a selective appraisal of some of the most relevant developments facilitated by the access to germ cells and embryos, this paper identifies some major ethical challenges created by the assisted reproduction technologies, with a special focus on Germany. The rapid progress in medical technology makes it difficult to prohibit or allow assisted reproduction technologies on the basis of such traditional criteria as the protection of human life, medical indications or a preference to adhere to natural processes. Instead, a more open discussion and a flexible application of ethical principles may be more helpful, such as: (i) considering DNA as a biological data file which allows potential access to a person's biography or identity; (ii) reconciling the protection of the early embryo with patients' needs; and (iii) placing both the mother and her embryo at the centre of bioethical and legal considerations, instead of exclusively relying on ethical principles and expert opinions with regard to the embryo alone. To continue the success of assisted reproduction, more attention should be given to the 'lifeworld' philosophy, as some authors have put it. [ABSTRACT FROM AUTHOR]

Many higher-income countries are struggling to make decent and affordable care available to their older populations. In response, some Germans are sending their ageing relatives to relatively high-end care homes within Eastern Europe and South-East Asia where the care tends to be more comprehensive and a lot cheaper. At the same time, this practice has caused much controversy within Germany, with some commentators calling it "inhumane" and "shameful." The aim of this article is to show that such criticisms are exaggerated. Whereas sending people to care homes in lower-income countries can be immoral, I argue that the most promising objections against it do not always apply and, to the extent that they do, do not always provide decisive reasons against sending people abroad. These objections maintain that such expatriations harm three different groups of individuals, namely the emigrants themselves; their friends and relatives; and vulnerable members of the receiving societies. [ABSTRACT FROM AUTHOR]

This article investigates the role of historical references and arguments in the current policy debate on non‐invasive prenatal testing (NIPT) in Germany. It analyses major documents and opinion statements, including the recent parliamentary debate (2019). The implementation of NIPT is accompanied by concerns and strong criticism, particularly in Germany. Many perceive the new test to be a problematic step that facilitates selective practices and is reminiscent of eugenics. Analysis of the German policy discourse shows that 'eugenics', and even more strongly, 'selection', are pivotal terms for rejecting NIPT and its coverage by public health insurance. They touch on a historical dimension in public deliberation, namely the fundamental distancing from the inhuman practices of the National Socialist period and anything that resembles them. However, using these terms to criticize prenatal genetic testing is controversial, and recent discourse demonstrates their avoidance as well, with many supporters of a limited coverage by public health insurance contrasting their approach with more widespread screening. Here, 'screening' has a negative connotation, and functions to demarcate the debate in a way that may reflect distance from certain modes of historical reasoning, but still expresses a special need to reconcile prenatal testing with the principles of dignity, inclusion and diversity. This article aims to elucidate the concerns involved in the national debates on prenatal testing and to increase awareness of the historical dimensions of the language and reasoning with which such methods are negotiated today and in future. [ABSTRACT FROM AUTHOR]

Health insurance coverage for incarcerated citizens is generally acceptable by Western standards. However, it creates internal tensions with the prevailing justifications for public healthcare. In particular, a conceptualization of medical care as a source of autonomy enhancement does not align with the decreased autonomy of incarceration and the needs-based conceptualization of medical care in cases of imprisonment; and rejecting responsibility as a criterion for assigning medical care conflicts with the use of responsibility as a criterion for assigning punishment. The recent introduction of sofosbuvir in Germany provides a particularly instructive illustration of such tensions. It requires searching for a refined reflective equilibrium regarding the scope, limits, and justifications of publicly guaranteed care. [ABSTRACT FROM AUTHOR]

Genetic testing has become a vehicle through which basic constitutional relationships between citizens and the state are revisited, reaffirmed, or rearticulated. The interplay between the is of genetic knowledge and the ought of government unfolds in the context of diverse imaginaries of the forms of human well-being, freedom, and flourishing that states have a duty to support. This article examines how the United Kingdom, Germany, and the United States governed testing for Alzheimer's disease, and how they diverged in defining potential harms, benefits, and objects of regulation. Comparison before and after the arrival of direct-to-consumer genetic tests reveals differences in national understandings of what it means to protect life and citizenship: in the United Kingdom, ensuring physical wellness through clinical utility; in the United States, protecting both citizens' physical well-being and freedom to choose through a framework of consumer protection; and in Germany, emphasizing individual flourishing and an unburdened sense of human development that is expressed in genetic testing law and policy as a commitment to the stewardship of personhood. Operating with their own visions of what it means to protect life and citizenship, these three states arrived at settlements that coproduced substantially different bioconstitutional regimes around Alzheimer's testing. [ABSTRACT FROM AUTHOR]

Child sexual abuse is a global problem with significant emotional, psychological, and financial implications to victims, perpetrators, and society. Most child sexual abuse prevention programs target young children or those who have already engaged in abusive behavior, in order to prevent further offending. There are numerous secondary prevention programs targeting individuals at-risk of various health conditions in an effort to reduce the likelihood they will go on to experience a particular illness or disease. Considerable research exists regarding the risk factors for engaging in child sexual abuse and more specifically the factors contributing to reoffense. We argue that engaging in secondary prevention programs for people with pedophilia, in order to prevent child sexual abuse, is an ethically responsible and necessary practice. Secondary prevention programs with this focus are reviewed, along with the implications of mandatory reporting in doing this work. [ABSTRACT FROM AUTHOR]

In Germany the perspectives of disabled people have a special weight in the public discourse on new genetics. This paper concentrates on the critique developed by activists of the disability rights movement. It focuses on the discourse's patterns and regularities which show a rough historical structure, and on the main and most influential arguments. As a first step, a theoretical framework is sketched. It draws on the work of French philosopher Michel Foucault as well as that of German literary scientist Jürgen Link. The concepts of "governmentality," "bio-power," and "normalism" help to understand that normalcy and eugenics are modern apparatuses of power/knowledge. In analyzing the discursive patterns of the German disability discourse on bioethics, in particular the "historical argument" and the "feminist argument," it can be shown that the disability rights discourse still considers power mainly as a disciplining, repressive force. The paper concludes with a plead for a renewal of the critique in order to better understand the bio-political matrix of neoliberal society which not only provides risk-oriented programs and policies, but also governs our subjective ways of thinking. [ABSTRACT FROM AUTHOR]

Abstract: Drawing from an ethics of care, relational approaches to autonomy have recently emerged in bioethics. Unlike individual autonomy with its emphasis on patients’ rights, choice, and self‐determination which has been the hallmark of bioethics consistent with the ideology of individualism in neoliberal democracies in Western countries, relational autonomy highlights the relatedness, interdependency, and social embeddedness of patients. By examining the mediating role that male Hospital Liaison Committee members in Germany play in facilitating care that supports Jehovah's Witnesses’ refusal of blood transfusions, this article moves beyond ‘dyadic relations’ and contexts of caregiving. It also contributes to a deeper understanding of care and relational conceptualizations of Witness patients’ autonomy globally. [ABSTRACT FROM AUTHOR]

Patient organizations (POs) represent patient collectives in health care policy. The inclusion of people with a ‘neuro-psychiatric’ condition poses a particular challenge for the organizational processes and political representation of such collectives. In recent years, new POs (POs of) have been established in the field of autism spectrum disorder and dementia that advocate a different agenda and have a different organizational structure than traditional POs (POs for). The divide between these two types of POs indicates a different standpoint with regard to who should be included on an organizational level, which voices are accepted and who should represent these voices on the political level. The inclusion and exclusion of voices needs to be normatively justified in order to be regarded legitimate representation of such a collective. With the help of Miranda Fricker's theory of epistemic injustice, we scrutinize whether and, if so, which types of epistemic injustices (wrongdoings to a person as a knower) can be found within POs' practices and the political field in which they operate, by analyzing 37 interviews with PO representatives, their members and policy makers. Our in-depth analysis indicates that persistent stereotypes hamper the inclusion of affected members both within POs and on the health political level. Being affected causes distrust in having the ‘capacity to know' in a two-fold way; it is assumed that those who can represent themselves are “not affected enough” to present valuable insights into the condition and those who have difficulties to express themselves due to their condition are excluded because of their affectedness. We conclude that our analysis of the epistemic practices of POs serves as a good starting point to address these shortcomings from a theoretical and practical perspective and offers a valuable starting point for bioethics to understand unjust structures in the health political context. [ABSTRACT FROM PUBLISHER]

The article aims to illuminate the recent debate in Germany about the legitimacy of circumcision for religious reasons. The aim is both to evaluate the new German law allowing religious circumcision, and to outline the resulting conflict between the surrounding ethical and legal issues. We first elucidate the diversity of legal and medical views on religious circumcision in Germany. Next we examine to what extent invasive and irreversible physical interventions on infant boys unable to given their consent should be carried out for non-medical reasons. To this end, the potential benefits and harms of circumcision for non-medical reasons are compared. We argue that circumcision does not provide any benefits for the 'child as a child' and poses only risks to boys. We then set out to clarify and analyse political (rather than ethical) justifications of the new circumcision law. We demonstrate through this analysis how the circumcision debate in Germany has been transformed from a legal and ethical problem into a political issue, due at least in part to Germany's unique historical context. Although such a particular political sensibility is entirely comprehensible, it raises particular problems when it comes to framing and responding to medical ethical issues - as in the case of religious circumcision. [ABSTRACT FROM AUTHOR]

In recent years, the rights of patients have assumed a more pivotal role in international discussion. Stricter laws on the protection of patients place greater priority on the perspective and the status of patients. The purpose of this study is to emphasize ethical aspects in communication, the role of patient advocates as contacts for the concerns and suggestions of patients, and how many problems of ethics disappear when communication is highlighted. We reviewed 680 documented cases of consultation in a 10-year period of patient advocates' activity at a big German university hospital with 1,300 beds. On the basis of this extensive material, the article will focus on the intersection of the advocate's work with the problems of patients in hospitals. Deficits in the level of communication between health care professionals and patients were frequently uncovered. Patients primarily complain about the lack of dialogue and empathy. Middle-aged patients consulted the patients' advocate disproportionately more often. Measured against this baseline, the group of 65 and older complained less frequently. Besides complaints the advocate was asked in more than one-third of all cases for information about medical matters, hospital regulations or administrative problems. Patients obviously see the advocate as a well-connected and ideally unbiased contact person for uncertainties concerning their malady or a potential stay in hospital. Those seeking help often set hope in the information given by the voluntary patient representative. It should be highly recommended for every German hospital to establish the position of a patient advocate. Furthermore, patients can profit from regular exchange between the advocate and the Ethics Committee, also, to help ensure that their rights are taken into account and implemented in an ethically desirable context. [ABSTRACT FROM AUTHOR]

Background: Because of its ethical and social implications, preimplantation sex selection is frequently the subject of debates. Methods: In 2006, we surveyed specialists in reproductive medicine in Germany using an anonymous questionnaire, including sociodemographic data and questions regarding ethical problems occurring in the practice of reproductive medicine. Most questions focused on preimplantation sex selection, including 10 case vignettes, since these enabled us to describe the most difficult and ethically controversial situations. This is the first survey among specialists in reproductive medicine regarding this topic in Germany. Results: 114 specialists in reproductive medicine participated, 72 males (63%) and 42 females (37%), average age was 48 years (age range 29–67 years). The majority of respondents (79%) favoured a regulation that limits the use of preimplantation sex selection only for medical reasons, such as X-linked diseases (including 18%: summoning an ethics commission for every case). A minority of 18% approved of the use of sex selection for non-medical reasons (4% generally and further 14% for family balancing). 90% had received obvious requests from patients. The highest approval (46%) got the counselling guideline against a preimplantation sex selection and advising a normal pregnancy, if preimplantation sex selection would be allowed in Germany. The majority (67%) was opposed the personal use of preimplantation sex selection for non-medical reasons, but would think about it in medical cases. In opposite to woman, 14% of the men were in favour of personal use for non-medical reasons (p = 0,043). 25% of specialists in reproductive medicine feared that an allowance of preimplantation sex selection would cause a shift in the sex ratio. Conclusions: The majority of German specialists in reproductive medicine opposes preimplantation sex selection for non-medical reasons while recommending preimplantation sex selection for medical reasons, e.g. X-linked diseases like haemophilia. [ABSTRACT FROM AUTHOR]

The article discusses the issues behind the legal prohibition of techniques of genetic enhancement. It tackles the applicability of the concept of human dignity as provided for by Article 1 Paragraph 1 of the German Constitution. It analyzes the attempts to extend the consitutional provision to an abstract idea of mankind based on a particular notion of the sanctity of the human species' nature. It also suggests the need for functional equivalents of religious arguments to establish an extensive restriction of alterations to human nature.

In the last decade, the pluripotency of human embryonic stem cells, i.e. their capacity to differentiate into any cell of the body and multiply endlessly, has encouraged visions and hopes for a new regenerative medicine. However, research with human embryos and cells derived from them is ethically controversial and different regulatory frameworks have developed across countries. In 2007, induced pluripotent stem (iPS) cells were generated that have been framed as a scientific breakthrough, which may provide an ethical alternative to embryonic stem cells. Drawing on interviews with embryonic stem cell researchers in Germany and the UK this article examines how scientists relate to iPS cells as new research objects. We show how three different aspects of stem cell science, namely ethical debate, therapeutic expectations and scientific uncertainty are tied together in the scientists' understanding and evaluation of different kinds of pluripotent stem cells. Furthermore, we show how the cells are set within a meaningful trajectory of scientific development that serves to justify previous and new research practices and stabilizes stem cell research as a field of scientific investigation. As a result, the article contributes to an understanding of the performative shaping of stem cell research as a contested and uncertain field of research. [ABSTRACT FROM AUTHOR]

The article examines the emergence of governmental bioethics in Great Britain, France and Germany, i.e. bodies, discourses and procedures meant to guide policy-making in terms of ethical considerations. It argues that governmental bioethics, marked by openness, transparency and participation, can be understood as a form of reflexive government in the realm of science governance. It grew out of the problematization of older forms of science governance based on ideas of effectiveness, scientific expertise and system stability, and operates through structuring and managing proper talk rather than intervening in processes of techno-scientific development. Yet, rather than challenging the commitment to techno-scientific 'progress', it stabilizes it through mechanisms of inclusion, involvement and mobilization: within the framework of proper ethical talk, participation can be employed to pursue rather than oppose system stability. [ABSTRACT FROM AUTHOR]

Information about the topics discussed during the Fourth International Colloquium of the International Association of Catholic Bioethicists (IACB) which was held at the Kardinal-Schulte-Haus in Germany on July 12-16, 2009 is presented. The event was participated by delegates from foreign countries including Africa, Asia, Australia, Europe, North and South America. The topics focused on ethical issues in the care of people living with Alzheimer's disease and other cognitive impairments.

Nazi eugenics is one of the main historical events influencing current popular as well as scholarly discussions of reproductive genetics. This influence, however, is open to different interpretations and social constructions. Based on 44 open interviews with Israeli and German genetic counselors, conducted in 2000-2003, our findings suggest that while the majority of German counselors reflected on Nazi eugenics as setting moral limits for contemporary repro-genetics, many Israeli counselors detached their contemporary practice from the wrongdoings of the past. Correspondingly, German counselors were far more sensitive towards the disability critique of repro-genetics than their Israeli counterparts. We conclude with a discussion of these two opposite positions, suggesting that the comparison of German and Israeli professionals reveals a profound complexity and involvedness in coming to terms with the “eugenic” lessons of the Holocaust, on both sides. In Germany, potential benefits of repro-genetics might be rejected due to an emphasis on a more universalistic lesson of the Holocaust regarding the value of human life and dignity. In Israel, a more particularistic lesson of the Holocaust regarding national Jewish survival, combined with a lack of public debate regarding medicalization and geneticization, might have promoted the advent of unregulated commercially and consumer-driven repro-genetics. [ABSTRACT FROM AUTHOR]

Germany and Israel represent opposite regulatory approaches and bioethical outlooks regarding genetic testing. This study examines lay attitudes (including attitudes of people affected by genetic diseases) in both countries towards genetic testing of adults, focusing on the differences between cultural and personal argumentations, as well as between affected and non-affected perspectives. With regard to three major emerging themes - medical technology/technocratic medicine; economic aspects of healthcare; and personal decision-making - a national contrast was apparent on the cultural level of argumentation, but not in the personal context of decision-making or in the concerns of people affected by genetic diseases. We conclude by discussing the interplay of national culture and individual experience in constructing arguments about the harms and benefits of genetic testing, and the implications for the study of cross-cultural bioethics in the context of “genetic responsibility”. [ABSTRACT FROM AUTHOR]

When reproductive and genetic technologies spurred an extended German policy debate, the issues at stake went beyond the technologies to include the very meaning of "ethics" and the respective roles of ethicists and of the public in thinking about ethical questions. [ABSTRACT FROM AUTHOR]

The current German criticism of HUGO centers around the term 'human dignity'; consenquentialist and autonomy-based arguments are used. The debate culminates in questioning the integrity of bioethics as a scholarly discipline and has created a heterogeneous coalition of disparate political and social groups that oppose any research that would facilitate genetic pre-selection of human characteristics. [ABSTRACT FROM AUTHOR]