Julia Fischer

BackgroundWhile the number of countries that have introduced or are trying to introduce statutory laws regulating the procedure of assisted dying is increasing, research has yet to address why some legislative attempts succeed and others fail. In Germany, which set out to regulate assisted suicide with an autonomy-based approach, two draft bills were unable to secure a parliamentary majority. This paper sets out to explain the underlying value disputes that contributed to the legislative failure.MethodsWe conducted an interpretative analysis of 108 speeches and 18 declarations to the votes delivered in four parliamentary debates and 44 contributions from parliamentarians in the expert hearing in the Committee on Legal Affairs in Germany. For analysis of the publicly available stenographic protocols of the debates, we used MAXQDA Analytics Pro. Using thematic analysis, we aimed to capture the underlying value disputes as the core ideas driving politicians’ statements to explain why the attempt at regulating assisted dying failed in Germany.ResultsOur analysis revealed that parliamentarians drew on beneficence-based reasoning when invoking the concept of autonomy. However, we identified two distinct camps that differ in how they interweave the concepts of autonomy and beneficence. Parliamentarians disagreed over which group is at greater risk of harm from inadequate assisted suicide legislation – eligible individuals denied access or ineligible individuals granted access. This determined whether they favoured a low-threshold or a more high-threshold approach toward regulating assisted suicide.DiscussionBy disagreeing over which group is at greater risk of harm from assisted dying legislation, German parliamentarians engaged in a discussion style characterized as a debate over false negatives and false positives. At present, scholarship offers no definitive basis for alleviating parliamentarians’ concerns about the risks of either false negatives or false positives. Our analysis underscores that scholarship should engage with ethical reasoning and guide assisted dying policy by offering empirical insights into regulatory options that need to operate with accepting certain risks.Trial registrationNot applicable.

Governments are increasingly inviting patient organizations to participate in healthcare policymaking. By inviting POs that claim to represent patients, representation comes into being. However, little is known about the circumstances under which governments accept POs as patient representatives. Based on the analysis of relevant legislation, this article investigates the criteria that self-help organizations, a special type of PO, must fulfil in order to be accepted as patient representatives by governments in Austria and Germany. Thereby, it aims to contribute to the discussion on the role of governments in steering SHOs. There are different degrees of regulation. Governments in both countries not only formulate explicit criteria for SHOs with respect to patient representation but also guide SHOs representing patients through implicit criteria for associations. We discuss the findings against concepts of responsiveness, authorization, and accountability. Our findings indicate that governmental steering is not negative per se as indicated by previous research but—depending on legislative criteria—can promote transparency and democratic quality in patient representation.

Emotional expressions provide strong signals in social interactions and can function as emotion inducers in a perceiver. Although speech provides one of the most important channels for human communication, its physiological correlates, such as activations of the autonomous nervous system (ANS) while listening to spoken utterances, have received far less attention than in other domains of emotion processing. Our study aimed at filling this gap by investigating autonomic activation in response to spoken utterances that were embedded into larger semantic contexts. Emotional salience was manipulated by providing information on alleged speaker similarity. We compared these autonomic responses to activations triggered by affective sounds, such as exploding bombs, and applause. These sounds had been rated and validated as being either positive, negative, or neutral. As physiological markers of ANS activity, we recorded skin conductance responses (SCRs) and changes of pupil size while participants classified both prosodic and sound stimuli according to their hedonic valence. As expected, affective sounds elicited increased arousal in the receiver, as reflected in increased SCR and pupil size. In contrast, SCRs to angry and joyful prosodic expressions did not differ from responses to neutral ones. Pupil size, however, was modulated by affective prosodic utterances, with increased dilations for angry and joyful compared to neutral prosody, although the similarity manipulation had no effect. These results indicate that cues provided by emotional prosody in spoken semantically neutral utterances might be too subtle to trigger SCR, although variation in pupil size indicated the salience of stimulus variation. Our findings further demonstrate a functional dissociation between pupil dilation and skin conductance that presumably origins from their differential innervation.