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The Federal Republic of Germany: a new forum for medical ethics.

The Federal Republic of Germany: A New Forum for Medical Ethics(*)

With the founding of the Academy for Ethics in Medicine (Akademie fur Ethik in der Medizin) in Goettingen in 1986, a central organization has been established and the various national and international approaches to biomedical ethics have finally been given a forum in the Federal Republic of Germany. The first concrete results of the academy's efforts have been the launching of the new journal Ethics in Medicine (Ethik in der Medizin, Springer-Verlag), which will serve as the principal German language periodical for ethics in medicine in the future, and the publication in 1988 of the Academy's "Recommendations for Curriculum Development in Ethical Questions of Medicine."[1] The latter was prepared for consultations between the Ministry of Education and the Association of Medical Schools with the intent of including ethical themes in the medical student's course of study.

Other works appearing in 1988 further exemplify currents in West German medical ethics. Among the topics addressed in contemporary publications are care of impaired newborns; reproductive medicine (IVF, for example); genetic technology and genetic counseling; crisis intervention (for example, in addiction, and malignant and cancerous diseases); rehabilitation; AIDS; euthanasia; the moral nature of medical-technical progress and medical action theory; nursing ethics; therapeutic relations; and public health. Five of these major themes will here be outlined briefly.

Published in the series Medicine in Ethics and Law, Ralf Peter's study on "Protection of Newborn Life"[12] undertakes an analysis of representations of the whole human being transmitted in folk narratives and cultural and religious traditions. Thus he parts from a positivistic legal framework and argues for a critical understanding of the maxims in various ethical traditions respecting legal and practical regulations for the care of impaired newborns. Peter questions the validity of modern medical distinctions between vegetative, individual, and personal life, and instead describes human life as a variable concept, subject to different cultural, religious, and historical understandings.

In Manipulated Destiny[3] geneticist Traute Schroeder-Kurth and theologian Stephan Wehowski examine the legal, ethical, and societal problems arising in modern reproductive medicine, particularly sterilization and prenatal diagnosis. Topics such as the uninhibited pursuit of the possible, the abandonment of traditional norms, and the repression of insights from nonmedical and nontechnical perspectives are critically assessed and the hopes, warnings, and plausible directives for this medical field are discussed.

Felix Anschutz, an internist (University of Heidelberg), reflects critically upon medical practice as a clinician in The Physician's Action, Foundations, Possibilities, Limits, and Inconsistencies.[4] He examines the difficulties that result from basing medical action on the analysis of a one-dimensional cause-effect relation. For Anschutz, ethics in medicine implies a consideration of whether medical action humanizes or dehumanizes health. His criticism of causal perspectives is supported by investigations in the theory of science, history, medical ethics, and medical law. He relates the emergence of a more humane sense of medical action to the realistic demand of meeting the actual expectations of institutions, patients, and society.

Another practice-oriented approach has been pursued by physician and psychotherapist Christoph Schmeling-Kludas (University of Hamburg) in his study, The Doctor-Patient Relationship on the Ward.[5] The need for more humanity in the hospital--a long standing desideratum--can only be achieved, he argues, if the relationship between doctor and patient is adequately considered. Before discussing specific case histories, Schmeling-Kludas examines the fundamental situation of the patient and the doctor in their respective institutional roles and explores the possibilities of humanizing clinical routine through therapeutic counseling and daily contact.

How can an adequate equilibrium be found between individual responsibility for one's health and public responsibility to allocate sufficient funds for health care in general? The philosopher Hans-Martin Sass (University of Bochum), with other nationally and internationally renowned contributors, investigates such questions against the background of the development of highly efficient medical sciences and the economics of political communities in Ethics and Public Health Care.[6] (*)Translated by Peter J. Tosic References [1]Akademie fur Ethik in der Medizin, "Empfehlung fur die Weiterentwicklung des Unterrichtsangebotes zu Fragen der Ethik in der Medizin," 1988. Reprinted in Ethik in der Medizin 1:1 (1989), 59-62. [2]Ralf Peter, Der Schutz des neugeborenen Lebens, insbesondere des mi[Beta]gebildeten Kindes, Medizin in Recht and Ethik, vol. 18 (Stuttgart: Enke, 1988). [3]Traute Schroeder-Kurth and Stephan Wehowski Das manipulierte Schicksal. Kunstliche Befruchtung, Embryotransfer und pranatale Diagnostik (Frankfurt: J. Schweitzer, 1988). [4]Felix Anschutz, Aerztliches Handeln. Grundlagen, Moglichkeiten, Grenzen, Widerspruche (Darmstadt: Wissenschaftliche Buchgesellschaft, 1987). Reprinted as paperback, 1988. [5]Christoph Schmeling-Kludas, Die Arizt-Patient-Beziehung im Stationsalltog (Weinheim: Edition Medizin, 1988). [6]Hans Martin-Sass, ed., Ethik und Offentliches Gesundheitswesen: ordnungsethische und ordnungs-politische Einflu[Beta]faktoren im offentlihen Gesundheitswesen (Berlin: Springer, 1988). Franz J. Illhardt is a theologian and assistant at the Institute for the History of Medicine and a scholar at the Academy for Ethics in Medicine; Eduard Seidler is professor of medicine and director of the Institute for the History of Medicine, Freiburg, and president of the Academy for Ethics in Medicine, Goettingen.
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Author:Illhardt, Franz J.; Seidler, Eduard
Publication:The Hastings Center Report
Date:Jul 1, 1989
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