Medical ethics

The medical ethics or medical ethics is concerned with the moral standard ratios , which for health should apply. It has evolved from medical ethics , but affects all persons, institutions and organizations working in the health care sector and, last but not least, patients. Related disciplines are medical humanities and bioethics .

Nowadays, basic values are the well-being of people, the prohibition to harm (“ primum non nocere ”) and the patient's right to self-determination (principle of autonomy ), more generally the principle of human dignity .

Much-discussed topics are abortion or the beginning of human life , the reproductive medicine , the life care , organ transplantation , gene therapy or stem cell transplantation . Institutions that deal with these topics are various ethics councils or the German Reference Center for Ethics in the Biosciences . This resulted not least from numerous moments of failure in medicine compared to today's principles and goals, cf. Eugenics or the murder of the sick during the Nazi era .

history

From antiquity to modern times

In almost all cultures there are solemn voluntary commitments on the part of doctors with regard to their medical skills, their relationships with patients and their own profession. The so-called oath of Hippocrates (approx. 4th century BC) is probably best known in Europe, where the Hippocratic medicine based on a high professional awareness among doctors had developed a medical ethic . It was reformulated in the Geneva doctor's vow (1948, 1968, 1983, 2017) in a contemporary way. In the European Middle Ages, medical ethics was based primarily on theological ethics and medical ethics was determined in particular by Christian charity and mercy, with scholasticism trying to combine the aspects of Christian theology and Aristotelian philosophy to be discussed.

Modern medical ethics from the 19th century

The founder of today's medical ethics is the English doctor Thomas Percival , who published the work Medical Ethics a year before his death in 1803 and thus coined the term. In it, he developed the first modern code of ethics, from which the American Medical Association was founded in 1847 and its first Code of Ethics was derived and adopted directly in many passages.

After 1945

Euthanasia programs and human experiments under National Socialism , Japanese experiments with prisoners of war, the abuse of psychiatry in the Soviet Union , certain research experiments in the USA and other painful experiences have shown that the medical professional ethos is not sufficient to prevent criminal abuse of medical knowledge and ambition. At the Nuremberg Doctors Trial (1947), a Nuremberg Code was drawn up, which represents the basis for carrying out necessary and ethically tenable medical experiments with people. In 1964 the World Medical Association passed a "Declaration on Ethical Principles for Medical Research on Humans" ( Declaration of Helsinki ), which was later updated several times (most recently in 2013) and is used in many countries.

The challenges posed by new developments in medicine from the 1970s (e.g. for prenatal diagnosis, cloning, etc.) ultimately led to an enormous differentiation in medical ethics. The handling of resources in the healthcare system must also be discussed from an ethical perspective.

Ethics committees

For human medical research , ethics committees were established in Germany in the 1980s at the medical faculties or at the state medical associations. When examining research projects, they are guided by legal regulations and the respective professional regulations for doctors. They have the status of an advisory body and only act upon request.

The German Medical Association set up a Central Ethics Commission in 1995: it has statements, among other things, on research with minors, on the (further) use of human body materials, on stem cell research , on the protection of persons unable to consent, on the protection of personal data in medical research and on Health care priorities published.

Since 2001, a political advisory body in the form of the German Ethics Council has existed in Germany to deal with medical ethics issues in civil society discourse .

Medical ethics at universities

The ethics of medicine is a separate research and teaching subject at German universities. Currently (as of June 2019) there are chairs at 20 German universities that deal with medical ethics. With the comparatively small number of own professorships, the ethics of medicine belongs to the group of small subjects (see also the list of small subjects ). It can be stated, however, that the ethics of medicine has gained in relevance at universities in recent years: since 1997 the number of locations and professorships has increased about fivefold.

Dental ethics

For dentists there is an ethics working group in the German Society for Dentistry, Oral and Maxillofacial Medicine (DGZMK), as well as ethics committees in some federal states at the State Chamber of Dentists. He deals with the development of basic ethical rules in dentistry .

The ethics of principles of Tom Beauchamp and James Childress

Tom Lamar Beauchamp and James F. Childress develop an ethics of principles in their book Principles of Biomedical Ethics . Four basic principles of medical ethics are a central part of this. The four principles are respect for patient autonomy, harm avoidance, care, and justice. The starting point of the ethics of principles is our everyday morality. It should be included in the process of ethical justification and decision-making. Beauchamps and Childress have found so much approval in medicine with their ethical theory, especially because they have designed the principles in such a way that, when applied, they offer scope for weighing up and prioritizing individual principles. The application of these four principles takes place in two steps. Basically, every principle has to be interpreted in every specific case. One speaks here of the interpretation. It must then be checked whether these principles conflict with one another or harmonize in such a specific case. If the former is the case, there is a need to weigh up. This process is known as weighting.

Justification of middle moral principles

The principled ethics of Beauchamp and Childress is on the one hand an ethic for application in medical contexts, on the other hand it also represents a philosophical position that differs from traditional theories. For two centuries, different ethical theories have been competing with one another (such as utilitarianism , Kantian ethics or contractualist ethics). So far, however, none of these ethics have prevailed. Because of this, and because of the need and urgency with which ethics were used in medicine, Beauchamp and Childress chose an approach that departed from the approach of a comprehensive ethical theory with a supreme moral principle and relied on "middle" principles concentrated, which should be compatible with various moral theories. They originally took up the idea of the prima facie obligation from William David Ross . According to Beauchamp and Childress, these principles should be tied to our everyday moral convictions ( common morality ). These are then reconstructed in a further process of interpretation, concretization and weighting and brought into a coherent context. We therefore speak of a reconstructive or coherentist justification approach. Beauchamp and Childress take up the idea of the equilibrium of thought from John Rawls here , but give everyday moral convictions a greater value. Now our everyday moral convictions are not only the starting point of this ethical theory, but it is also a kind of corrective at the same time. Thus, ethical theory and moral practice are interrelated. The ethical theory offers orientation in practice, but then it has to prove itself. These "middle" principles are not absolute, but rather subsidiary to general moral principles. This means that they only come into play if they do not conflict with higher or equal obligations. Accordingly, the different principles often have to be weighed against each other.

The four principles

1. Autonomy

The principle of autonomy (also respect for autonomy , English respect for autonomy ) grants every person competence, freedom of choice and the right to promote the ability to make decisions or to self-determination. It includes the requirement of informed consent prior to any diagnostic and therapeutic measure and the consideration of the patient's will, wishes, goals and values.

2. Prevention of harm (non-maleficiency)

The principle of damage avoidance (English nonmaleficence ) demands that harmful interventions be avoided (taking into account the risk-benefit ratio and observing individual values). This is based on the traditional medical principle “ primum non nocere ”. At first this seems self-evident. However, there are cases when it is very difficult to decide what will help the patient or what will harm them. This is especially the case in highly invasive therapies such as chemotherapy.

3. Welfare (benefit)

The principle of care (also assistance , English beneficence ) obliges the practitioner to act actively, which promotes and benefits the well-being (especially life, health and quality of life ) of the patient. Traditional medical ethics formulates a similar principle (Salus aegroti suprema lex), which however takes precedence over all others. In the ethics of principles there are four principles on the same level. The principle of care is often in conflict with the principle of autonomy and the principle of avoiding harm. The benefits and harms of a measure should be carefully weighed up, taking into account the wishes, goals and values of the patient.

4. Justice

The principle of justice (also equality, English justice ) calls for a fair and appropriate distribution of health services while respecting resources. The same cases should be treated equally, and in the event of unequal treatment, morally relevant criteria should be specified. The principle calls for a fair distribution of health management. For example, the resources and capacities of the hospitals must be distributed fairly. Every case of illness of a person which is equivalent, i.e. H. is equivalent to another case, calls for equal treatment. Unequal cases may be treated differently, but only if the cases show morally relevant differences. Unequal treatment is not justified based on nationality, gender, age, place of residence, religion, social status or previous behavior in society. Previous criminal offenses or professional activities may not be included in the decision. For example, a beggar is treated on an equal footing with a lawyer if they have the same symptoms and the same chances of survival. The decision regarding medical treatment must be factually justified, transparent and fair.

Application example of the four principles

Using the concrete example, the four principles are first applied to the case, and then a weighing up based on the established basis is carried out. To apply the principles, it is now believed that there is the possibility of treating a person with advanced lung cancer with chemotherapy. Since this would be the third therapy, the patient speaks out against the treatment despite intact chances of recovery. If the case is interpreted from the point of view of the first principle, the patient's negative right to freedom applies, whose autonomy would be preserved by negating the therapy. In a specific case, it would also have to be checked whether the patient has the intellectual possibilities for free will formation so that one can speak of the patient's will. In this example this aspect is assumed. Since there is a sufficient probability that chemotherapy will not harm the patient, the principle of avoiding harm is fulfilled. Both the physician and the patient must be aware of the fact that side effects can occur during chemotherapy (see prerequisites for the principle of autonomy). The principle of care obliges the doctor to act actively. While the principle of no harm can be used both as an argument for the implementation and for the suspension of further chemotherapy, the principle of care dictates therapeutic action in this case, since the well-being of the patient is promoted. In this example, the principle of justice is only applied to the extent that the consideration must also play a role as to whether another patient may not be denied treatment due to the limited capacities of the hospital. Since the patient's treatment is factually well founded, further consideration is not necessary here. After the interpretation of the four principles comes the weighing up. A final judgment cannot be made here based on the principles, as there is no general weighting. However, with the help of the principles it was possible to uncover what the moral conflict in the example described consists of. Is the patient's right to self-determination or the doctor's duty of care given more weight?

Topics of medical ethics

The topics discussed in medical ethics include the following.

Doctor-patient relationship

The doctor-patient relationship is characterized by an asymmetry in skills: the doctor usually knows more than the patient. This poses the problem of paternalism : should the doctor decide for the patient? However, this would violate the patient's right to self-determination. It is therefore assumed that the doctor has a duty to inform the patient about all the possibilities and, in principle, is not allowed to perform any intervention without the patient's consent.

Termination of pregnancy

An abortion describes the premature termination of a pregnancy , whereby the human fetus intentionally does not survive the procedure. Abortion has long been a controversial issue. Religious and ethical ideas, social claims and women’s right to self-determination are in conflict . This results in different ethical assessments and legal regulations. These range from great freedom of choice for pregnant women to prohibitions with harsh punishment. This raises the ethical questions. For example, questions about the fundamental rights of women and the right to life of the human fetus are in conflict. Does a fetus have the right to life, and if so, from when? Can a woman decide whether or not to keep the embryo and to what extent can the partner have a say? Does it matter under which circumstances the fetus was formed, that is to say, it should be noted whether or not the woman was deprived of her freedom when the embryo was formed? Should the woman's circumstances affect her right to have an abortion?

Euthanasia and euthanasia

The terms euthanasia and euthanasia are generally used as synonyms. The term euthanasia has its origins in ancient Greece. It comes from the word Thanatos, which means something like "premature death" and was the counterpart of the term Hypnos , which denoted a death that was "at the time", e.g. B. through sleep. In ancient Greece this death was considered a “good death” or a glorious way of dying. In the 19th and 20th In the 19th century this term took on a new meaning and was increasingly used in a social Darwinian sense. The climax of this development was the use of this term by the National Socialists, who used this term to describe the killing of the disabled / seriously ill. That is why most people avoid this term in the German language.

Types of euthanasia: In euthanasia, a distinction is made between active and passive euthanasia . Active euthanasia is targeted killing to shorten the suffering of the patient. The doctor or a third party deliberately administers an agent that leads to immediate death. In general, active euthanasia is prohibited in many countries around the world, but the situation is different in some BENELUX countries such as Belgium or the Netherlands. There, killing is permitted on request, at least under certain conditions. Passive euthanasia is the renouncement of taking up or breaking off life support measures. It is not a medical termination of treatment, but the aim of the treatment is changed. This should promote the well-being of the patient ( palliation ) and no longer increase life expectancy through healing (curative). The dying process started is allowed. Indirect euthanasia is the pain-relieving treatment of the patient while accepting an impairment of life expectancy. For example, a patient who is in great pain is given a high dose of morphine. This may affect their mental abilities until death or shorten their life expectancy, but their physical well-being is promoted. In this way, death wishes can be prevented. When assisted suicide is about to raise the patient or the patient a lethal substance that can take the patient or the patient without any external assistance. In Switzerland, assisting suicide is generally not a criminal offense, but only if it is done for selfish reasons.

A relevant question in the ethical discussion is whether it is legitimate to neglect the goal of healing in order to promote current well-being. In the case of passive and indirect euthanasia, this question is largely answered in the affirmative in medicine. However, active euthanasia is more controversial: this is prohibited by law in most countries. Most of the discussion is about the supposed will of a dying person. Opponents argue as follows: Medical and psychological efforts should be used to prevent a person from finding themselves in such a hopeless situation that they ask for euthanasia. Positive developments on the part of patients who want to return to life are stifled by active euthanasia. The euthanasia may have a conflict of interest. The closer they are to the person requesting euthanasia, the more difficult it is for them to accept euthanasia. Proponents argue that it is not always possible to provide enough relief from a patient's pain and suffering while pursuing a curative goal. People who have no prospect of a cure often find themselves in a hopeless situation in which life appears to them as an expense and torment for themselves and those who are by them. Right to self-determination: Everyone has the right to decide for himself about his life and about the end of his life.

Prenatal diagnostics

In prenatal diagnostics , diagnostic examinations are carried out on the fetus in the womb and on the pregnant woman. As with abortion, this raises the ethical question of what status the fetus has. In addition, questions arise such as whether this reduces the value of disabled people in society and whether there is undue pressure on the parents-to-be to carry out such examinations, even if they do not want to.

Preimplantation Diagnostics

The preimplantation genetic diagnosis (PGD) is a method of assisted reproduction, which serves before the institution in which the genetic material of an embryo, womb to capture and possible chromosomes to test -Damage. PGD requires in vitro fertilization (IVF). This means that the egg cell is fertilized "in the glass" (in vitro) and thus outside of the female body. In order to keep the chance of successful fertilization as high as possible, several egg cells are usually fertilized. PGD makes it possible to ensure that only "healthy" embryos are inserted into the uterus. There is a specific selection based on genetic characteristics. In most countries, PGD is subject to strict legal regulations. In Switzerland, PGD may only be carried out because of infertility or because of the risk of a serious hereditary disease. Similar legal provisions can be found in most European countries.

Various ethical questions arise: Does PGD represent a violation of human dignity? Does approval of PGD represent discrimination against the disabled? When does "being human" begin? Does PGD interfere too strongly with nature? Is PGD the first step towards designer babies? (future possibilities / future understanding of people).

Stem cell transplant

In stem cell transplantation , stem cells are transferred from a donor to a recipient. This can save lives. However, stem cell transplantation is also associated with risks for donors and recipients.

Organ transplant

The organ transplantation is a medical procedure of transplanting organic body parts or body tissues saved the lives or the situation of permanently damaged patients can be sustainably improved. Medicine differentiates between organ removal and organ donation or between living and dead donation. Organ transplantation is a process valued by many, but there are some ethical issues to consider.

Criterion of brain death In ethics, it is generally agreed that brain death of the donor is a necessary condition ("criterion of brain death"). How exactly can brain death be determined and defined?

Distribution According to which criteria should the organs be distributed?

Animal-to-Human Transplantation: Should Animals Be Allowed to be Killed to Donate Their Organs to Humans?

Donor: Must the donor have expressly consented to a possible organ donation before she dies ("consent solution"), is it sufficient if she has expressly opposed it ("contradiction solution") or should there even be an organ donation obligation?

Determination: Who has the right to decide on the guidelines for organ donation, in particular the questions mentioned above regarding donors? Should this be decided at the state level or set universally? How do you deal with different regulations?

Entitlement: Who is entitled to a new organ? Do everyone have the same right or are criteria such as age, financial possibilities, short-term / long-term prognosis or lifestyle changes after receiving the new organ taken into account?

Religious freedoms : To what extent can religious freedoms be restricted in order to save the life of a (religious) person?

Personal rights: How do you deal with patents who have limited capacity for judgment? Should minors, for example, have a say or is the decision about organ removal or donation left to the parents alone?

In conclusion, it turns out that despite the advantages of this medical progress in organ transplantation, many ethical questions remain unanswered. Only ethicists agree that the commercial trade in organs and the violent removal of organs are ethically highly reprehensible.

Gene therapy

Some diseases can be cured by replacing defective genes . Appropriate nucleic acids are inserted into the sick body cells of a patient. They are integrated into the DNA in place of the defective gene, allowing the protein synthesis of the previously missing proteins to take place. In this way, a defective gene can be replaced with a healthy copy and a disease can be treated. To prevent the "new genetic information" from being passed on to a patient's children, in many countries gene therapy may only be carried out in the somatic cells.

With the help of therapeutic interventions in the genome, it seems possible today to heal a number of congenital defects. The consequences for those affected and for their descendants are, however, completely unclear because long-term results are lacking. Should such treatments be allowed, although long-term consequences cannot be ruled out? There is also the risk that the nucleic acids added to the diseased cell will be integrated into the DNA at the wrong place. This can cause another serious illness. Is this risk acceptable? Is it allowed to change anything in a person's genetic makeup?

Neuro-enhancement

As neuro-enhancement refers to the taking of psychoactive substances that cause mental performance and is known alternatively as the "brain doping". In pharmacy, three groups are distinguished:

1) Illegal stimulants

2) Prescription Stimulants and Non-Stimulants

3) Free / For Sale Stimulants and Non-Stimulants

The substances work in different ways. The most common, however, are “reuptake inhibitors” (e.g. MPH), which block presynaptic transporters (e.g. norepinephrine or dopamine transporters) to prevent neurotransmitters from re- entering the presynapse . Thus, the neurotransmitters stay longer and in high concentration in the blood and cause a short-term increase in performance.

What are the dangers?

A great danger in taking such psychoactive substances is dependence. As soon as the body has adapted to this effect or has got used to it, it develops certain withdrawal symptoms as soon as the substance is no longer in the blood. So the side effects could be drastic.

Another danger is that as soon as the effect wears off, one can fall into a "feeling low" because the body adapts to the high concentration of bsw. Has become accustomed to dopamine in the blood and therefore no longer reacts as strongly to small amounts of dopamine in the blood. This can lead to depression. One consequence of this is the constant fluctuations in the ability to concentrate and the emotional states. This can not only affect the person concerned, but also affect their environment.

A major disadvantage of this brain doping is the only short-term increase in the ability to concentrate. A long-term improvement cannot be seen with the means researched today.

What can tempt you to take advantage of such opportunities to increase performance?

The advantages that arise when taking psychoactive substances include an improvement in the ability to concentrate, the mental efficiency which is increased and the motor skills are improved. It can also increase focus and creativity and make us productive for longer. Which of course would lead to being able to overtake or catch up with the competition. They can also be used to break boundaries and gain new experiences.

Ethical justifiability With regard to ethical justifiability, there are several factors that make a clear judgment difficult. One problem is, among other things, the prisoner's dilemma that if everyone or the other takes it, I have to take it too in order to be able to survive in competition. In addition, boundaries are expanded that would remain closed without psychoactive substances. Some counter-arguments are, for example, the long-term side effects, which we are not yet aware of. Or whether the side effects are too high compared to the benefits that the substances bring us.

In the future Research into the development of performance-enhancing stimulants focuses primarily on hypothetical future drugs with fewer side effects and clearly demonstrable, performance-enhancing effects and not on the drugs already on the market.

literature

Introductions

Tom L. Beauchamp, James F. Childress: Principles of Biomedical Ethics. 6th edition. Oxford University Press, 2008, ISBN 0-19-533570-8 .
Jürgen Barmeyer: Practical medical ethics: modern medicine in the field of tension between scientific thinking and humanitarian mandate - a guide for students and doctors. 2nd, heavily revised edition. LIT-Verlag, Münster u. a. 2003, ISBN 3-8258-4984-8 .
Axel W. Bauer : Medical ethics at the beginning of the 21st century. Theoretical concepts, clinical problems, medical action. JA Barth, Heidelberg, Leipzig 1998, ISBN 3-335-00538-4 .
Axel W. Bauer: Normative delimitation. Topics and dilemmas in medical and bioethics in Germany. Springer VS, Wiesbaden 2017, ISBN 978-3-658-14033-5 .
Jan P. Beckmann : Ethical challenges of modern medicine. Verlag Karl Alber, Freiburg / Munich 2010, ISBN 978-3-495-48394-7 .
Michael Coors / Tatjana Grützmann / Tim Peters (eds.): Interculturality and Ethics. Dealing with strangeness in medicine and care. (= Edition Ethik . Volume 13). Edition Ruprecht, Göttingen 2014, ISBN 978-3-8469-0162-5 .
Bernhard Irrgang : Outline of medical ethics. UTB Verlag, Munich 1995, ISBN 978-3-8385-1821-3 .
AR Jonsen, M. Siegler, WJ Winslade: Clinical Ethics 2006. Deutscher Ärzte-Verlag, Cologne 2007, ISBN 978-3-7691-0524-7 (A practical aid to ethical decision-making in medicine).
Hartmut Kreß: Medical Ethics. Kohlhammer, Stuttgart, ISBN 3-17-017176-3 .
Georg Marckmann: What actually is principle-based medical ethics? In: Ärzteblatt Baden-Württemberg. Volume 56, No. 12, 2000, pp. 499-502.
Bettina Schöne-Seifert : Medical ethics. In: Julian Nida-Rümelin (ed.): Applied ethics. The area ethics and their theoretical foundation. A manual (= Kröner's pocket edition . Volume 437). Kröner, Stuttgart 1996, ISBN 3-520-43701-5 .
Thomas Schramme: Bioethics. Introductions. Campus Verlag, Frankfurt, ISBN 3-593-37138-3 .
Claudia Wiesemann , Nikola Biller-Andorno: Medical ethics . Thieme, Stuttgart 2004, ISBN 3-13-138241-4 .
Urban Wiesing (ed.): Ethics in medicine. A study book. Reclam, Ditzingen, 5th expanded, updated and fully revised edition, Reclam, Ditzingen 2020, ISBN 978-3-15-019337-2 ; 4th expanded and completely revised edition, Reclam, Ditzingen 2012; 2nd edition 2004; 1st edition under the title: Ethics in Medicine. A reader . Philipp Reclam jun., Stuttgart 2000.

Nursing ethics

Joachim Heil, Bastian Zimmermann: Medical ethics as ethics of care. Towards clinical pragmatism. De Gruyter, Berlin 2015, ISBN 978-3-11-044999-0 .
Marion Großklaus-Seidel: Ethics in everyday care: How carers can reflect and justify their actions. Kohlhammer, Stuttgart 2002, ISBN 3-17-016075-3 .
Ulrich HJ Körtner : Basic course in nursing ethics. 3. Edition. Vienna 2017, ISBN 978-3-7089-1486-2 .
Dieter Sperl: Ethics of Nursing: Responsible thinking and acting in nursing practice. Kohlhammer, 2002, ISBN 3-17-017314-6 .

Other general works

Dietrich von Engelhardt , Christian Hick: ethics, medical. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 371-374.
Reiner Anselm / Julia Inthorn / Lukas Kaelin / Ulrich HJ Körtner (eds.): Autonomy and power. Interdisciplinary perspectives on medical ethical decisions , Edition Ethik Volume 12, Edition Ruprecht, Göttingen 2014, ISBN 978-3-8469-0127-4 .

euthanasia

Josef Girshovich: Who Owns Death? On the right to life and euthanasia. Kein & Aber, Zurich 2014, ISBN 978-3-0369-5648-0 .
Kurt Bayertz, Andreas Frewer: Ethical controversies at the end of human life . Palm & Enke , Erlangen [a. a.] 2002, ISBN 3-7896-0584-0 .
G. Pott: Ethics at the end of life. Intuitive ethics, concern for a good death, patient autonomy, euthanasia. Schattauer, Stuttgart 2007.

Resource allocation

Alexander Dietz: Just health reform? Allocation of resources in medicine from an ethical perspective, Campus-Verlag , Frankfurt am Main 2011, ISBN 978-3-593-39511-1 .

other topics

G. Marckmann, J. Meran: Ethical aspects of oncological research 2006. Deutscher Ärzte-Verlag, Cologne 2007, ISBN 978-3-7691-0527-8 .
Christiane Woopen : The importance of quality of life from an ethical perspective. Z Evid Fortbild Qual Gesundh.wesen (ZEFQ) 108 (2014), 140–145; doi : 10.1016 / j.zefq.2014.03.002 .

Web links

Individual evidence

↑ Jutta Kollesch , Diethard Nickel : Ancient healing art. Selected texts from the medical writings of the Greeks and Romans. Philipp Reclam jun., Leipzig 1979 (= Reclams Universal Library. Volume 771); 6th edition ibid 1989, ISBN 3-379-00411-1 , p. 16 f.

^ The Geneva Vow of the World Medical Association, doi: 10.1007 / s00481-018-0471-2

^ Dietrich von Engelhardt: Ethics, medical (Middle Ages). In: Werner E. Gerabek et al. (Ed.): Enzyklopädie Medizingeschichte. 2005, pp. 371-373; here: p. 371.

↑ Karl-Heinz Leven: The doctor: a "servant of art". In: Deutsches Ärzteblatt . Volume 115, No. 24, June 15, 2018, p. A1164-1167.

↑ https://www.degruyter.com/abstract/j/jfwe.2015.19.issue-1/jwiet-2015-0116/jwiet-2015-0116.xml The new Helsinki Declaration

↑ Small Subjects: Medical Ethics on the Small Subjects portal. Retrieved June 18, 2019 .

^ Hans-Jürgen Gahlen: 10 years working group ethics of the DGZMK - a success story. In: German Dental Journal. Volume 75, No. 2, 2020.

↑ Beauchamp, Childress: Principles of Biomedical Ethics. 2009.

↑ G. Marckmann. 2000, pp. 499-502.

↑ See Beauchamp and Childress 1979.

↑ See Marckmann 2000, p. 499.

↑ See Marckmann 2000.

↑ See Wiesing 2012, Chapter 5.

↑ See Wiesing 2012, Chapter 7; Singer 2013, chapter 6.

↑ See Singer 2013, Chapter 7.

↑ See Swiss Criminal Code, Art. 115.

↑ See e.g. B. Michael Wunder, July 18, 2015, Link .

↑ See e.g. B. Ingrid Matthäus Maier, July 28, 2015, Link . See also Wiesing 2012, Chapter 9.

↑ See Wiesing 2012, Chapter 12.

↑ See Wiesing 2012, Chapter 11.

↑ See Wiesing 2012, Chapter 12.

↑ See Wiesing 2012, Chapter 13.

↑ See Wiesing 2012, Chapter 16.

[1] Jutta Kollesch , Diethard Nickel : Ancient healing art. Selected texts from the medical writings of the Greeks and Romans. Philipp Reclam jun., Leipzig 1979 (= Reclams Universal Library. Volume 771); 6th edition ibid 1989, ISBN 3-379-00411-1 , p. 16 f.