TY - JOUR A1 - Wetzel, Anna-Jasmin A1 - Koch, Roland A1 - Preiser, Christine A1 - Müller, Regina A1 - Klemmt, Malte A1 - Ranisch, Robert A1 - Ehni, Hans-Jörg A1 - Wiesing, Urban A1 - Rieger, Monika A. A1 - Henking, Tanja A1 - Joos, Stefanie T1 - Ethical, legal, and social implications of symptom checker Apps in primary Health Care (CHECK.APP) BT - protocol for an interdisciplinary mixed methods study JF - JMIR Research Protocols N2 - Background: Symptom checker apps (SCAs) are accessible tools that provide early symptom assessment for users. The ethical, legal, and social implications of SCAs and their impact on the patient-physician relationship, the health care providers, and the health care system have sparsely been examined. This study protocol describes an approach to investigate the possible impacts and implications of SCAs on different levels of health care provision. It considers the perspectives of the users, nonusers, general practitioners (GPs), and health care experts. Objective: We aim to assess a comprehensive overview of the use of SCAs and address problematic issues, if any. The primary outcomes of this study are empirically informed multi-perspective recommendations for different stakeholders on the ethical, legal, and social implications of SCAs. Methods: Quantitative and qualitative methods will be used in several overlapping and interconnected study phases. In study phase 1, a comprehensive literature review will be conducted to assess the ethical, legal, social, and systemic impacts of SCAs. Study phase 2 comprises a survey that will be analyzed with a logistic regression. It aims to assess the user degree of SCAs in Germany as well as the predictors for SCA usage. Study phase 3 will investigate self-observational diaries and user interviews, which will be analyzed as integrated cases to assess user perspectives, usage pattern, and arising problems. Study phase 4 will comprise GP interviews to assess their experiences, perspectives, self-image, and concepts and will be analyzed with the basic procedure by Kruse. Moreover, interviews with health care experts will be conducted in study phase 3 and will be analyzed by using the reflexive thematical analysis approach of Braun and Clark. Results: Study phase 1 will be completed in November 2021. We expect the results of study phase 2 in December 2021 and February 2022. In study phase 3, interviews are currently being conducted. The final study endpoint will be in February 2023. Conclusions: The possible ethical, legal, social, and systemic impacts of a widespread use of SCAs that affect stakeholders and stakeholder groups on different levels of health care will be identified. The proposed methodological approach provides a multifaceted and diverse empirical basis for a broad discussion on these implications. KW - symptom checker apps KW - self-diagnosis KW - self-triage KW - digitalization in KW - primary care KW - general practitioners KW - symptom checker KW - app KW - mobile app; Y1 - 2022 U6 - https://doi.org/10.2196/34026 SN - 1929-0748 VL - 11 IS - 5 PB - JMIR Research Protocols CY - Toronto ER - TY - JOUR A1 - Burmeister, Christiane A1 - Ranisch, Robert A1 - Brand, Cordula A1 - Müller, Uta T1 - Organisationsethik in Einrichtungen des Gesundheitswesens JF - Ethik in der Medizin : Organ der Akademie für Ethik in der Medizin T2 - Organizational ethics in health care institutions Y1 - 2021 U6 - https://doi.org/10.1007/s00481-021-00639-w SN - 0935-7335 SN - 1437-1618 VL - 33 IS - 2 SP - 153 EP - 158 PB - Springer CY - Berlin ; Heidelberg ER - TY - JOUR A1 - Almeida, Mara A1 - Ranisch, Robert T1 - Beyond safety: mapping the ethical debate on heritable genome editing interventions JF - Humanities and Social Sciences Communications N2 - Genetic engineering has provided humans the ability to transform organisms by direct manipulation of genomes within a broad range of applications including agriculture (e.g., GM crops), and the pharmaceutical industry (e.g., insulin production). Developments within the last 10 years have produced new tools for genome editing (e.g., CRISPR/Cas9) that can achieve much greater precision than previous forms of genetic engineering. Moreover, these tools could offer the potential for interventions on humans and for both clinical and non-clinical purposes, resulting in a broad scope of applicability. However, their promising abilities and potential uses (including their applicability in humans for either somatic or heritable genome editing interventions) greatly increase their potential societal impacts and, as such, have brought an urgency to ethical and regulatory discussions about the application of such technology in our society. In this article, we explore different arguments (pragmatic, sociopolitical and categorical) that have been made in support of or in opposition to the new technologies of genome editing and their impact on the debate of the permissibility or otherwise of human heritable genome editing interventions in the future. For this purpose, reference is made to discussions on genetic engineering that have taken place in the field of bioethics since the 1980s. Our analysis shows that the dominance of categorical arguments has been reversed in favour of pragmatic arguments such as safety concerns. However, when it comes to involving the public in ethical discourse, we consider it crucial widening the debate beyond such pragmatic considerations. In this article, we explore some of the key categorical as well sociopolitical considerations raised by the potential uses of heritable genome editing interventions, as these considerations underline many of the societal concerns and values crucial for public engagement. We also highlight how pragmatic considerations, despite their increasing importance in the work of recent authoritative sources, are unlikely to be the result of progress on outstanding categorical issues, but rather reflect the limited progress on these aspects and/or pressures in regulating the use of the technology. KW - Ethics KW - Medical humanities KW - Science, technology and society Y1 - 2022 U6 - https://doi.org/10.1057/s41599-022-01147-y SN - 2662-9992 VL - 9 IS - 1 PB - Springer Nature CY - London ER - TY - JOUR A1 - Burmeister, Christiane A1 - Iller, Ariane A1 - Ranisch, Robert A1 - Brand, Cordula A1 - Staib, Tobias A1 - Müller, Uta T1 - Jenseits der Klinik BT - Konzeptionelle Überlegungen zum Ethiktransfer in dezentralen Einrichtungen des Gesundheitswesens am Beispiel der BruderhausDiakonie Reutlingen BT - Conceptual considerations on transferring ethics to decentralized health care facilities using the example of the BruderhausDiakonie Reutlingen JF - Ethik in der Medizin : official journal of the German Academy of Ethics in the Medicine N2 - Definition of the problem Medical and nursing care often takes place within complex organizational structures that comprise numerous facilities at numerous locations. We introduce an interactive ethical concept, designed in cooperation with the diaconal foundation BruderhausDiakonie Reutlingen and the International Centre for Ethics in Science, University of Tubingen, to address the particular needs of such organizations. Arguments Therefore we portray the interactive Nijmegen Model which combines an ethics committee located at the management level and situational ethical case deliberations on the ward in order to bring together two indispensable ways of ethical reflection in organizations: "top-down"/"bottom-up". We illustrate the challenges of implementing the said model into the organizational construction of the BruderhausDiakonie and how to address these by means of conception and implementation. Conclusion Considering the implementational challenges that we encountered, the Nijmegen Model needs to be enhanced by introducing a link between the committee and the case deliberations. We delineate the basic elements and the requirements for such a position while reporting our initial practical experience with this model. N2 - Unser Beitrag stellt ein interaktives Ethik-Konzept vor, das in Zusammenarbeit der BruderhausDiakonie Reutlingen und der Universität Tübingen entwickelt wurde, um den Eigenheiten und Bedarfen einer komplexen Organisationsstruktur gerecht zu werden, die mehrere Geschäftsfelder und Standorte unter sich vereint. Wir skizzieren die Grundzüge des interaktiven Nijmegener Modells, in dem die Kooperation eines auf Leitungsebene angesiedelten Komitees und situationsbezogener Fallbesprechungen ein fruchtbares Zusammenspiel zweier unverzichtbarer Reflexionsweisen bewirken soll („Top-Down“/„Bottom-Up“). Wir zeigen auf, welche Herausforderungen sich bei der Implementierung dieses Modells in die konkrete Aufbauorganisation der BruderhausDiakonie ergaben, und mit welchen konzeptionellen oder „implementationstechnischen“ Mitteln ihnen begegnet wurde. Im Zentrum steht dabei die Erweiterung des Nijmegener Modells um ein Verbindungselement, welches die Zusammenarbeit zwischen zentralem Ausschuss und dezentralen Fallbesprechungen koordiniert und das interaktive Moment des Modells erst ermöglicht. T2 - Beyond the clinic KW - Organizational ethics KW - Implementation KW - Ethics committee KW - Case KW - deliberations KW - Nijmegen interactive model KW - Practice report KW - Moral case KW - deliberation KW - Organisationsethik KW - Implementierung KW - Ethikkomitee KW - Fallbesprechung KW - Praxisbericht KW - Nimwegener Modell KW - Ethische Fallbesprechung Y1 - 2021 U6 - https://doi.org/10.1007/s00481-021-00634-1 SN - 0935-7335 SN - 1437-1618 VL - 33 IS - 2 SP - 275 EP - 292 PB - Springer CY - Berlin ; Heidelberg ER - TY - JOUR A1 - Ranisch, Robert T1 - Consultation with Doctor Twitter BT - consent Fatigue, and the role of developers in digital medical ethics JF - The American journal of bioethics : ajob Y1 - 2021 U6 - https://doi.org/10.1080/15265161.2021.1926595 SN - 1526-5161 SN - 1536-0075 VL - 21 IS - 7 SP - 24 EP - 25 PB - Routledge, Taylor & Francis Group CY - Philadelphia, Pa. ER -