Silke Schicktanz

ZusammenfassungDie enorme Bedeutung, die Patientenverfügungen in der aktuellen ethisch-rechtlichen Diskussion zukommt, steht in gewissem Widerspruch zur geringen öffentlichen Bereitschaft, eine solche abzufassen. Dies wirft die ethische Frage auf, welche Argumente für das Abfassen von Patientenverfügungen sprechen. Zentral sind hierbei strebensethische Aspekte, die auf das Wünschenswerte und Lebenskluge einer solchen Entscheidung abheben. Mit einem um die soziokulturelle Perspektive erweiterten Identitätskonzept lässt sich für die Patientenverfügung als sinnvolles Instrument der Selbst-Deutung und Lebensplanung argumentieren. Zugleich verweist die soziokulturelle Dimension auf neue ethische Probleme der Interpretation durch Dritte und der Stellvertreterrolle. Dabei wird ein Defizit in der sozial-empirischen und ethischen Auseinandersetzung um die Bedeutung von Interpretation, Beratung und Verantwortung von Stellvertretern offenkundig.

Recent advances in biomarkers may soon make it possible to identify persons at high risk for late-onset Alzheimer’s disease at a presymptomatic stage. Popular demand for testing is increasing despite the lack of cure and effective prevention options and despite uncertainties regarding the predictive value of biomarker tests. This underscores the relevance of the ethical, cultural and social implications of predictive testing and the need to advance the bioethical debate beyond considerations of clinical consequences. Our qualitative study included three groups of affected persons: People with mild neurocognitive disorder, their relatives and family caregivers of people with dementia. We explored their moral motivations regarding predictive, biomarker-based testing and preclinical diagnostics. We interviewed affected individuals in Germany and Israel. Transcripts of 12 focus groups and 12 semistructured interviews were content analysed with a focus on the moral motivations of affected persons in their justification of why they accept or reject predictive testing and early diagnosis. We grouped the underlying aspects of moral motivation into four ethical categories: beneficence as a form of personal utility focusing on well-being, the ties of responsibility linking families and their individual members, the importance of self-determination by later life planning and notions of a good life. In general, cultural parallels among these motives were very obvious. Cultural variation occurred mainly in openness to suicide, scepticism about test validity and emphasis on personal autonomy. The study underscores the importance of counselling for life-planning issues and of informing test candidates about problems with test validity and about the ambiguity of test results. All data relevant to the study are included in the article or uploaded as supplementary information.

Unter dem Begriff ›Anti-Aging‹ wird seit etwa drei Jahrzehnten eine wachsende Anzahl medizinischer wie außermedizinischer Präparate bzw. Verfahren konzipiert, entwickelt und eingesetzt, die allgemein der Bekämpfung des Alterns dienen sollen. Die so genannte Anti-Aging-Medizin will in den Alterungsprozess des menschlichen Körpers eingreifen, um ihn zu verlangsamen, aufzuhalten oder rückgängig zu machen. Dabei variieren die konkreten Angriffspunkte, Vorgehensweisen und Zielsetzungen der einzelnen Ansätze durchaus beträchtlich.

This volume presents the ethical implications of risk information as related to genetics and other health data for policy decisions at clinical, research and societal levels. Ethical, Social and Psychological Impacts of Genomic Risk Communication examines the introduction of new types of health risk information based on faster, cheaper and larger sets of genetic or genomic analysis. Synthesising the results of a five-year interdisciplinary project, it explores the unsolved ethical and social questions around the sharing of this data, such as: What is best practice in risk communication? What are the normative presumptions and ethical consequences of an increased individual responsibility for ones' health? And how does one deal with the gap between the knowledge of risk and the lack of therapeutic options which often exist for complex diseases, such as dementia or some types of cancer? Drawing on contributions from over twenty experts in the field, this collection examines these questions from a liberal bioethics' perspective, advocating for contextual and cultural-sensitive ethical discussions. This book will be of great interest to students and scholars of theoretical and clinical medical ethics, medical sociology, risk communication and ethics of risk, as well as professionals in clinical genetics.

My following comparative analysis is based on two main questions: How can we best understand and describe the social practices of modern medicine in a particular cultural context? And: What can we learn for our moral thinking from such a comparative approach? I will answer these two questions by engaging the comprehensive studies from law, medical sociology/anthropology and ethics in this volume from three different cultural/national contexts: Germany, Israel and India in a fictional, comparative discourse. Hereby, I identify three cross-themes of surrogacy which I will discuss from a normative point of view: unsolved ethical concerns such as exploitation, child’s best interest and unethical motivations, a naturalised parenthood as global-cultural imperative, and the need for transnational discourses beyond relativism.

This chapter gives a brief overview of the composition of the volume and explains why it is important to undertake a detailed scholarly analysis and comparison of the following ethico-legal regimes of surrogacy and egg donation: the permissive-unregulated but transitory regime of India; the permissive regime of Israel, although highly regulated by professional, medical and religious norms, and the extremely restrictive regime of Germany, being legally permeable for particular forms of cross-border reproductive practice despite the non-permissive national law. It uses an interdisciplinary lens to examine how the ethical, social, legal and cultural issues are interwoven in each regime. Moreover, we highlight the importance of a comparative analysis to understand how local developments cannot be isolated from each other, but deeply influence each other through transnational markets, modern media and the transfer of knowledge, people and body parts.

Zusammenfassung. Die Verpflanzung tierischer Organe (Xenotransplantation) wird als neue Zukunftsoption der Transplantationsmedizin gehandelt. Bei dieser Technik stellen sich zahlreiche ungelöste biomedizinische und ethische Probleme. Der Beitrag diskutiert vorrangig die medizinethischen Probleme für Patienten, Ärzte und Dritte, die sich bei klinischen Versuchen zur Verfügung stellen, und problematisiert die Abwägung der Chancen und Risiken. Zudem zeigen inhaltliche Parallelen zwischen den xenogenen Infektionsrisiken und der HIV-Debatte der 8oer Jahre mögliche Szenarien für den weiteren Debatten-Verlauf auf.