Urban Wiesing - Academia.edu (original) (raw)
Papers by Urban Wiesing
E-book-Version erhältlich ab dem 26. August unter www.kohlhammer.de 26. August 2014 Zusammenfassu... more E-book-Version erhältlich ab dem 26. August unter www.kohlhammer.de 26. August 2014 Zusammenfassung: Wir brauchen ein Gesetz Der Bundestag wird nach der Sommerpause über eine gesetzliche Regelung des assistierten Suizids debattieren. Das Fehlen einer solchen Regelung verursacht erhebliche Rechtsunsicherheit und führt zu unnötigem Leiden. Der Staat wird damit seinen Pflichten in Bezug auf den Respekt vor der Selbstbestimmung seiner Bürgerinnen und Bürger, aber auch der Fürsorge und des Lebensschutzes nicht gerecht. Vier erfahrene Hochschullehrer aus den Bereichen Recht, Ethik und Palliativmedizin melden sich deswegen mit einem wissenschaftlich begründeten Gesetzesvorschlag zu Wort.
Journal of Clinical Medicine, 2020
Uterus transplantation (UTx) can provide a route to motherhood for women with Mayer–Rokitansky–Kü... more Uterus transplantation (UTx) can provide a route to motherhood for women with Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS), a congenital disorder characterized by uterovaginal aplasia, but with functional ovaries. Based on our four successful living-donor transplantations and two resulting births, this analysis presents parameters relevant to standardizing recipient/donor selection, UTx surgery, and postoperative treatment, and their implementation in routine settings. We descriptively analyzed prospectively collected observational data from our four uterus recipients, all with MRKHS, their living donors, and the two newborns born to two recipients, including 1-year postnatal follow-ups. Analysis included only living-donor/recipient pairs with completed donor/recipient surgery. Two recipients, both requiring ovarian restimulation under immunosuppression after missed pregnancy loss in one case and no pregnancy in the other, each delivered a healthy boy by cesarean section. We conc...
Translational Psychiatry, 2020
To examine the hypothesis that normalization of low circulating leptin levels in patients with an... more To examine the hypothesis that normalization of low circulating leptin levels in patients with anorexia nervosa ameliorates hyperactivity, three seriously ill females with hyperactivity were treated off-label with metreleptin (recombinant human leptin) for up to 14 days. Drive for activity, repetitive thoughts of food, inner restlessness, and weight phobia decreased in two patients. Surprisingly, depression improved rapidly in all patients. No serious adverse events occurred. Due to obvious limitations of uncontrolled case series, placebo-controlled clinical trials are mandatory to confirm the observed rapid onset of beneficial effects. Our findings suggest an important role of hypoleptinemia in the mental and behavioral phenotype of anorexia nervosa.
Gesnerus, 1997
This article tries to identify the theory of medical history in the work of Richard Koch (1882-19... more This article tries to identify the theory of medical history in the work of Richard Koch (1882-1949). Rejecting the wide-spread notion of medicine as a science he vigorously argued for a self-image of medicine as an art. From that point of view he built up his theory of medical history and historiography. He wanted medical historiography to be part of practical medicine.
Ethik in der Medizin, 2020
Der Streit um die Sterbehilfe ist in die Jahre gekommen, in der Bundesrepublik hoch emotionalisie... more Der Streit um die Sterbehilfe ist in die Jahre gekommen, in der Bundesrepublik hoch emotionalisiert, die Argumente liegen auf dem Tisch, sind lange bekannt. Die Gräben der Gegner und Befürworter einer Liberalisierung sind verfestigt, die Diskussion ist verfahren. Was kann eine weitere Publikation da noch beitragen? Ganz einfach: sachliche Gründe und präzise Argumentationen. Und die liefert Héctor Wittwer reichlich und überzeugend, mit breitem Rückgriff auf die philosophische Tradition, und nicht zuletzt, indem er wichtige Differenzierungen beachtet. Die Frage, ob der Suizid an sich moralisch gut sei oder nicht, werde der Komplexität der Situationen nicht gerecht. Man müsse fragen, wie ein Suizid in welchen Situationen zu bewerten sei. Wittwer untersucht zahlreiche Einwände gegen die Möglichkeit eines moralisch zulässigen Suizids. Das Ergebnis: "Es gibt keine überzeugende Begründung für ein ausnahmsloses moralisches Verbot der Selbsttötung." (S. 197) Denn schließlich sei das Ursprungsmotiv für seriöse Überlegungen zur Sterbehilfe höchst gewichtig, "das moralische Recht auf Selbstbestimmung" (S. 197). Allerdings fände dieses Recht seine Grenzen, wenn Entscheidungen für einen Suizid unvernünftig getroffen würden. Dann-wohl in der Mehrheit der Fälle-ließe sich ein paternalistisches Recht begründen, vor den Folgen der Tat zu bewahren. Aber eben nicht in allen Fällen. Und dort gebe es keine hinreichenden Argumente, warum unter bestimmten Bedingungen die Beihilfe dazu nicht gerechtfertigt sein sollte. Der Autor plädiert für eine Freigabe des ärztlich assistierten Suizids bei Volljährigen, die an einer unheilbaren körperlichen Krankheit leiden, nach Urteil von Experten zurechnungsfähig sind und über Alternativen aufgeklärt wurden (S. 221). Er wendet sich gegen die Zulassung einer Tötung auf Verlangen.
Bioethics, 2018
Some of the recent criticisms published during and after the last revision process of the Declara... more Some of the recent criticisms published during and after the last revision process of the Declaration of Helsinki are directed at its basic legitimacy. In this article we want to have a closer look at the two criticisms we consider to be the most fundamental. The first criticism questions the legitimate authorship of the World Medical Association to publish a document such as the Declaration. The second fundamental criticism we want to examine argues that the last revision process failed to meet the standards for fair, democratic procedures. Although both criticisms deny the formal legitimacy of the Declaration in the most fundamental way, they have never been addressed in detail in a single article. We refute most of the related arguments. However, acknowledging some of the points made, improvements for future revision processes and versions of the Declaration of Helsinki are outlined.
Indian Journal of Medical Ethics, 2017
On December 6, 2016, the Council of International Organisations of Medical Sciences published a n... more On December 6, 2016, the Council of International Organisations of Medical Sciences published a new version of its guidelines with the title "International Ethical Guidelines for Health-related Research Involving Humans." In this article we briefly describe the revision process and the structure and content of these guidelines. We outline some of its main guidelines such as the ones on social value, post-trial access, and risk-benefit ratio. In our overall evaluation we come to the conclusion that the CIOMS guidelines manage to strike a balance between the protection of human participants in health-related research and the promotion of such research activities in an exemplary way. The guidelines combine key principles with a guide to their application based on the state of the art in research ethics. Thus they represent a timely and indispensable orientation for researchers, ethics committees, and other stakeholders in health-related research.
Handbuch Angewandte Ethik, 2011
Deutsches Ärzteblatt international, 2010
Journal of Medical Ethics, 2013
In his critical comment on our paper in this journal, Shaw argues that &a... more In his critical comment on our paper in this journal, Shaw argues that 'false assumptions' which we have criticised are in fact correct ('Neuroenhancers, addiction and research ethics'). He suggests that the risk of addiction to neuroenhancers may not be relevant, and that safety and research in regard to neuroenhancement do not pose unique ethical problems. Here, we demonstrate that Shaw ignores key empirical research results, trivialises addiction, commits logical errors, confuses addictions and passions, argues on a speculative basis, and fails to distinguish the specific ethical conditions of clinical research from those relevant for research in healthy volunteers. Therefore, Shaw's criticism cannot convince.
Journal of Medical Ethics, 2012
The present work critically examines two assumptions frequently stated by supporters of cognitive... more The present work critically examines two assumptions frequently stated by supporters of cognitive neuroenhancement. The first, explicitly methodological, assumption is the supposition of effective and side effect-free neuroenhancers. However, there is an evidence-based concern that the most promising drugs currently used for cognitive enhancement can be addictive. Furthermore, this work describes why the neuronal correlates of key cognitive concepts, such as learning and memory, are so deeply connected with mechanisms implicated in the development and maintenance of addictive behaviour so that modification of these systems may inevitably run the risk of addiction to the enhancing drugs. Such a potential risk of addiction could only be falsified by in-depth empirical research. The second, implicit, assumption is that research on neuroenhancement does not pose a serious moral problem. However, the potential for addiction, along with arguments related to research ethics and the potential social impact of neuroenhancement, could invalidate this assumption. It is suggested that ethical evaluation needs to consider the empirical data as well as the question of whether and how such empirical knowledge can be obtained.
Das Gesundheitswesen, 2002
ABSTRACT Der Beitrag zeichnet die Kontroverse 'ber die Frage nach, ob die gesetzlichen Kr... more ABSTRACT Der Beitrag zeichnet die Kontroverse 'ber die Frage nach, ob die gesetzlichen Krankenversicherungen zur Erstattung der Kosten f'r die Behandlung erektiler Dysfunktion verpflichtet sind. Ne- ben der Frage nach den Befugnissen und der Frage der Wirt- schaftlichkeit war und ist in dieser Kontroverse vor allem um- stritten, ob erektile Dysfunktion 'berhaupt eine Krankheit im Sinne des Rechts der gesetzlichen Krankenversicherung dar- stellt. Dies zwingt zu allgemeineren Nberlegungen bez'glich der Definierbarkeit und der normativen - sozialrechtlichen und ethischen - Relevanz des Krankheitskonzepts f'r die Begr'n- dung und Begrenzung des sozial finanzierten medizinischen Leistungsangebots. Abstract The article describes the controversy about the question whether statutory social health insurances are obliged to reimburse the costs for the treatment of erectile dysfunction. Next to the ques- tion whether the 'Bundesausschuss der 1rzte und Krankenkas- sen' was entitled to decide it was highly controversial whether erectile dysfunction is a disease according to the laws of social insurance. This enforces more general considerations regarding the possibility to define disease and the relevancy of a concept of disease for the justification and limitation of socially financed services in medicine.
Ethik in der Medizin, 2006
BMJ, 2006
Values are important parts of our lives. But values and conscience have different roles in public... more Values are important parts of our lives. But values and conscience have different roles in public and private life. They should influence discussion on what kind of health system to deliver. But they should not influence the care an individual doctor offers to his or her patient. The door to "value-driven medicine" is a door to a Pandora's box of idiosyncratic, bigoted, discriminatory medicine. Public servants must act in the public interest, not their own. Contributors and sources: JS is a professional medical ethicist with experience in practising general and emergency medicine. This article arose from reflections on the literature and his experience Competing interests: None declared.
Medicine, Health Care and Philosophy
The article critically responds to "A Planetary Health Pledge for Health Professionals in th... more The article critically responds to "A Planetary Health Pledge for Health Professionals in the Anthropocene" which was published by Wabnitz et al. in The Lancet in November 2020. It focuses on the different roles and responsibilities of a physician. The pledge is criticised because it neglects the different roles, gives no answers in case of conflicting goals, and contains numerous inconsistencies. The relationship between the Planetary Health Pledge and the Declaration of Geneva is examined. It is argued that the Planetary Health Pledge should have supplemented the Declaration of Geneva instead of changing it.
Veröffentlichungen des Instituts für Deutsches, Europäisches und Internationales Medizinrecht, Gesundheitsrecht und Bioethik der Universitäten Heidelberg und Mannheim, 2016
In einer pluralistischen Gesellschaft muss man sich bei einem ethischen Kommentar zunachst darube... more In einer pluralistischen Gesellschaft muss man sich bei einem ethischen Kommentar zunachst daruber im Klaren sein, wie sich die Ethik vernunftigerweise zu einer politischen Entscheidung des Parlaments ausern kann. Dabei gilt es zu berucksichtigen, dass es die eine Ethik in dieser Gesellschaft nicht gibt, dass die Burger ganz unterschiedliche Vorstellungen von einem gelingenden Leben (und Sterben!) haben und dass sich stattdessen die fur alle verbindliche Moral auf wenige Grundsatze begrenzt, die ihre juristische Ausformulierung in den zentralen Artikeln des Grundgesetzes gefunden haben. Insofern macht es wenig Sinn, die Entscheidung des Parlaments aus der Perspektive einer bestimmten Partialethik zu kommentieren.
E-book-Version erhältlich ab dem 26. August unter www.kohlhammer.de 26. August 2014 Zusammenfassu... more E-book-Version erhältlich ab dem 26. August unter www.kohlhammer.de 26. August 2014 Zusammenfassung: Wir brauchen ein Gesetz Der Bundestag wird nach der Sommerpause über eine gesetzliche Regelung des assistierten Suizids debattieren. Das Fehlen einer solchen Regelung verursacht erhebliche Rechtsunsicherheit und führt zu unnötigem Leiden. Der Staat wird damit seinen Pflichten in Bezug auf den Respekt vor der Selbstbestimmung seiner Bürgerinnen und Bürger, aber auch der Fürsorge und des Lebensschutzes nicht gerecht. Vier erfahrene Hochschullehrer aus den Bereichen Recht, Ethik und Palliativmedizin melden sich deswegen mit einem wissenschaftlich begründeten Gesetzesvorschlag zu Wort.
Journal of Clinical Medicine, 2020
Uterus transplantation (UTx) can provide a route to motherhood for women with Mayer–Rokitansky–Kü... more Uterus transplantation (UTx) can provide a route to motherhood for women with Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS), a congenital disorder characterized by uterovaginal aplasia, but with functional ovaries. Based on our four successful living-donor transplantations and two resulting births, this analysis presents parameters relevant to standardizing recipient/donor selection, UTx surgery, and postoperative treatment, and their implementation in routine settings. We descriptively analyzed prospectively collected observational data from our four uterus recipients, all with MRKHS, their living donors, and the two newborns born to two recipients, including 1-year postnatal follow-ups. Analysis included only living-donor/recipient pairs with completed donor/recipient surgery. Two recipients, both requiring ovarian restimulation under immunosuppression after missed pregnancy loss in one case and no pregnancy in the other, each delivered a healthy boy by cesarean section. We conc...
Translational Psychiatry, 2020
To examine the hypothesis that normalization of low circulating leptin levels in patients with an... more To examine the hypothesis that normalization of low circulating leptin levels in patients with anorexia nervosa ameliorates hyperactivity, three seriously ill females with hyperactivity were treated off-label with metreleptin (recombinant human leptin) for up to 14 days. Drive for activity, repetitive thoughts of food, inner restlessness, and weight phobia decreased in two patients. Surprisingly, depression improved rapidly in all patients. No serious adverse events occurred. Due to obvious limitations of uncontrolled case series, placebo-controlled clinical trials are mandatory to confirm the observed rapid onset of beneficial effects. Our findings suggest an important role of hypoleptinemia in the mental and behavioral phenotype of anorexia nervosa.
Gesnerus, 1997
This article tries to identify the theory of medical history in the work of Richard Koch (1882-19... more This article tries to identify the theory of medical history in the work of Richard Koch (1882-1949). Rejecting the wide-spread notion of medicine as a science he vigorously argued for a self-image of medicine as an art. From that point of view he built up his theory of medical history and historiography. He wanted medical historiography to be part of practical medicine.
Ethik in der Medizin, 2020
Der Streit um die Sterbehilfe ist in die Jahre gekommen, in der Bundesrepublik hoch emotionalisie... more Der Streit um die Sterbehilfe ist in die Jahre gekommen, in der Bundesrepublik hoch emotionalisiert, die Argumente liegen auf dem Tisch, sind lange bekannt. Die Gräben der Gegner und Befürworter einer Liberalisierung sind verfestigt, die Diskussion ist verfahren. Was kann eine weitere Publikation da noch beitragen? Ganz einfach: sachliche Gründe und präzise Argumentationen. Und die liefert Héctor Wittwer reichlich und überzeugend, mit breitem Rückgriff auf die philosophische Tradition, und nicht zuletzt, indem er wichtige Differenzierungen beachtet. Die Frage, ob der Suizid an sich moralisch gut sei oder nicht, werde der Komplexität der Situationen nicht gerecht. Man müsse fragen, wie ein Suizid in welchen Situationen zu bewerten sei. Wittwer untersucht zahlreiche Einwände gegen die Möglichkeit eines moralisch zulässigen Suizids. Das Ergebnis: "Es gibt keine überzeugende Begründung für ein ausnahmsloses moralisches Verbot der Selbsttötung." (S. 197) Denn schließlich sei das Ursprungsmotiv für seriöse Überlegungen zur Sterbehilfe höchst gewichtig, "das moralische Recht auf Selbstbestimmung" (S. 197). Allerdings fände dieses Recht seine Grenzen, wenn Entscheidungen für einen Suizid unvernünftig getroffen würden. Dann-wohl in der Mehrheit der Fälle-ließe sich ein paternalistisches Recht begründen, vor den Folgen der Tat zu bewahren. Aber eben nicht in allen Fällen. Und dort gebe es keine hinreichenden Argumente, warum unter bestimmten Bedingungen die Beihilfe dazu nicht gerechtfertigt sein sollte. Der Autor plädiert für eine Freigabe des ärztlich assistierten Suizids bei Volljährigen, die an einer unheilbaren körperlichen Krankheit leiden, nach Urteil von Experten zurechnungsfähig sind und über Alternativen aufgeklärt wurden (S. 221). Er wendet sich gegen die Zulassung einer Tötung auf Verlangen.
Bioethics, 2018
Some of the recent criticisms published during and after the last revision process of the Declara... more Some of the recent criticisms published during and after the last revision process of the Declaration of Helsinki are directed at its basic legitimacy. In this article we want to have a closer look at the two criticisms we consider to be the most fundamental. The first criticism questions the legitimate authorship of the World Medical Association to publish a document such as the Declaration. The second fundamental criticism we want to examine argues that the last revision process failed to meet the standards for fair, democratic procedures. Although both criticisms deny the formal legitimacy of the Declaration in the most fundamental way, they have never been addressed in detail in a single article. We refute most of the related arguments. However, acknowledging some of the points made, improvements for future revision processes and versions of the Declaration of Helsinki are outlined.
Indian Journal of Medical Ethics, 2017
On December 6, 2016, the Council of International Organisations of Medical Sciences published a n... more On December 6, 2016, the Council of International Organisations of Medical Sciences published a new version of its guidelines with the title "International Ethical Guidelines for Health-related Research Involving Humans." In this article we briefly describe the revision process and the structure and content of these guidelines. We outline some of its main guidelines such as the ones on social value, post-trial access, and risk-benefit ratio. In our overall evaluation we come to the conclusion that the CIOMS guidelines manage to strike a balance between the protection of human participants in health-related research and the promotion of such research activities in an exemplary way. The guidelines combine key principles with a guide to their application based on the state of the art in research ethics. Thus they represent a timely and indispensable orientation for researchers, ethics committees, and other stakeholders in health-related research.
Handbuch Angewandte Ethik, 2011
Deutsches Ärzteblatt international, 2010
Journal of Medical Ethics, 2013
In his critical comment on our paper in this journal, Shaw argues that &a... more In his critical comment on our paper in this journal, Shaw argues that 'false assumptions' which we have criticised are in fact correct ('Neuroenhancers, addiction and research ethics'). He suggests that the risk of addiction to neuroenhancers may not be relevant, and that safety and research in regard to neuroenhancement do not pose unique ethical problems. Here, we demonstrate that Shaw ignores key empirical research results, trivialises addiction, commits logical errors, confuses addictions and passions, argues on a speculative basis, and fails to distinguish the specific ethical conditions of clinical research from those relevant for research in healthy volunteers. Therefore, Shaw's criticism cannot convince.
Journal of Medical Ethics, 2012
The present work critically examines two assumptions frequently stated by supporters of cognitive... more The present work critically examines two assumptions frequently stated by supporters of cognitive neuroenhancement. The first, explicitly methodological, assumption is the supposition of effective and side effect-free neuroenhancers. However, there is an evidence-based concern that the most promising drugs currently used for cognitive enhancement can be addictive. Furthermore, this work describes why the neuronal correlates of key cognitive concepts, such as learning and memory, are so deeply connected with mechanisms implicated in the development and maintenance of addictive behaviour so that modification of these systems may inevitably run the risk of addiction to the enhancing drugs. Such a potential risk of addiction could only be falsified by in-depth empirical research. The second, implicit, assumption is that research on neuroenhancement does not pose a serious moral problem. However, the potential for addiction, along with arguments related to research ethics and the potential social impact of neuroenhancement, could invalidate this assumption. It is suggested that ethical evaluation needs to consider the empirical data as well as the question of whether and how such empirical knowledge can be obtained.
Das Gesundheitswesen, 2002
ABSTRACT Der Beitrag zeichnet die Kontroverse 'ber die Frage nach, ob die gesetzlichen Kr... more ABSTRACT Der Beitrag zeichnet die Kontroverse 'ber die Frage nach, ob die gesetzlichen Krankenversicherungen zur Erstattung der Kosten f'r die Behandlung erektiler Dysfunktion verpflichtet sind. Ne- ben der Frage nach den Befugnissen und der Frage der Wirt- schaftlichkeit war und ist in dieser Kontroverse vor allem um- stritten, ob erektile Dysfunktion 'berhaupt eine Krankheit im Sinne des Rechts der gesetzlichen Krankenversicherung dar- stellt. Dies zwingt zu allgemeineren Nberlegungen bez'glich der Definierbarkeit und der normativen - sozialrechtlichen und ethischen - Relevanz des Krankheitskonzepts f'r die Begr'n- dung und Begrenzung des sozial finanzierten medizinischen Leistungsangebots. Abstract The article describes the controversy about the question whether statutory social health insurances are obliged to reimburse the costs for the treatment of erectile dysfunction. Next to the ques- tion whether the 'Bundesausschuss der 1rzte und Krankenkas- sen' was entitled to decide it was highly controversial whether erectile dysfunction is a disease according to the laws of social insurance. This enforces more general considerations regarding the possibility to define disease and the relevancy of a concept of disease for the justification and limitation of socially financed services in medicine.
Ethik in der Medizin, 2006
BMJ, 2006
Values are important parts of our lives. But values and conscience have different roles in public... more Values are important parts of our lives. But values and conscience have different roles in public and private life. They should influence discussion on what kind of health system to deliver. But they should not influence the care an individual doctor offers to his or her patient. The door to "value-driven medicine" is a door to a Pandora's box of idiosyncratic, bigoted, discriminatory medicine. Public servants must act in the public interest, not their own. Contributors and sources: JS is a professional medical ethicist with experience in practising general and emergency medicine. This article arose from reflections on the literature and his experience Competing interests: None declared.
Medicine, Health Care and Philosophy
The article critically responds to "A Planetary Health Pledge for Health Professionals in th... more The article critically responds to "A Planetary Health Pledge for Health Professionals in the Anthropocene" which was published by Wabnitz et al. in The Lancet in November 2020. It focuses on the different roles and responsibilities of a physician. The pledge is criticised because it neglects the different roles, gives no answers in case of conflicting goals, and contains numerous inconsistencies. The relationship between the Planetary Health Pledge and the Declaration of Geneva is examined. It is argued that the Planetary Health Pledge should have supplemented the Declaration of Geneva instead of changing it.
Veröffentlichungen des Instituts für Deutsches, Europäisches und Internationales Medizinrecht, Gesundheitsrecht und Bioethik der Universitäten Heidelberg und Mannheim, 2016
In einer pluralistischen Gesellschaft muss man sich bei einem ethischen Kommentar zunachst darube... more In einer pluralistischen Gesellschaft muss man sich bei einem ethischen Kommentar zunachst daruber im Klaren sein, wie sich die Ethik vernunftigerweise zu einer politischen Entscheidung des Parlaments ausern kann. Dabei gilt es zu berucksichtigen, dass es die eine Ethik in dieser Gesellschaft nicht gibt, dass die Burger ganz unterschiedliche Vorstellungen von einem gelingenden Leben (und Sterben!) haben und dass sich stattdessen die fur alle verbindliche Moral auf wenige Grundsatze begrenzt, die ihre juristische Ausformulierung in den zentralen Artikeln des Grundgesetzes gefunden haben. Insofern macht es wenig Sinn, die Entscheidung des Parlaments aus der Perspektive einer bestimmten Partialethik zu kommentieren.