Definition of the problem Medical ethics education is commonly centered on dilemma situations and decision-making frameworks. This focus overlooks a substantial part of everyday medical practice and training, which is not only characterized by decisions but also by uncertainty, diffuse discomfort, and ambivalent emotional experiences. These everyday moral phenomena remain largely underrepresented in medical ethics teaching. Arguments The article argues that such everyday experiences can be conceptualized as experiences of irritation. Drawing on insights from educational theory, it demonstrates the epistemic and pedagogical potential of perceiving and reflecting on experiences of irritation. The article further discusses reasons for the marginalization of irritations in medicine, including a strong orientation toward action and problem-solving, and a medical curriculum that does not systematically foster self-reflexive practices. Conclusion Based on a concrete teaching project, the article demonstrates how experiences of irritation can be systematically integrated into medical ethics education through ethnographic exercises. It concludes by advocating for the creation of curricular and institutional spaces in which such experiences can emerge and be critically reflected upon.
Definition of the problem In German-speaking countries, teaching and learning units on the history of the health professions under National Socialism-in particular their involvement in racial policy and medical crimes-are established at many educational institutions and anchored in local and national catalogs of learning objectives. However, it often remains unclear what specific learning objectives are to be pursued: is it a matter of imparting basic historical knowledge, providing ethical guidance, or shaping professional self-image? Furthermore, the intertwining of the two disciplines raises the question of their relation. Appropriation in both directions can be problematic: affirmative learning of supposed "lessons from history" in the sense of strongly normative demands from a history didactics perspective, or conversely, from an ethics didactics perspective, the use of history as the "most extreme example" of unethical behavior to raise awareness of current ethical issues. In such a tense relationship, the combination of historical and ethical learning objectives appears desirable, but its concrete implementation raises fundamental didactic questions. Resolution Against this background, we propose a convergence of history and ethics teaching by differentiating the relevant competencies for both subjects into subcompetencies and comparing them. Arguments We argue that highlighting disciplinary similarities and differences can fundamentally clarify how history and ethics can be taught in an interdisciplinary manner. To this end, we identify four elements that characterize an interdisciplinary, competency-oriented teaching and learning process: 1. Addressing the emotional dimension of historical and ethical learning, 2. Formulating and exploring historical and ethical questions, 3. Reflecting on perspectivity, partiality, and narrativity, and 4. Conceiving historical and ethical thinking as a basis for action.
Background The extent to which the legacy of National Socialist medical crimes has influenced-or should influence-current bioethical debates remains contested. Using the development of psychiatric ethics in Germany as a case study, this article reconstructs the shifting discursive references to the medical crimes of National Socialism. Method The analysis is based on bioethics literature, contributions published in psychiatric journals, and 13 expert interviews. Results The findings show that three central strands of discourse-medical and bioethics in psychiatry, psychiatric reform, and the reckoning with the Nazi past-emerged simultaneously in the 1970s but initially proceeded largely independently of one another. Only from the 1990s onward can a substantive integration of remembrance work and an increasingly differentiated discourse in psychiatric ethics be observed. Within this discursive trajectory, we identified two competing bioethical orientations that shape differing attitudes toward people with psychiatric conditions and the professional ethical perspectives derived from them. One places patient autonomy at the center, while the other primarily emphasizes patient welfare. These divergent normative interpretations also inform differing views on how past ethical failures of the profession under National Socialism might be prevented in the future, and they continue to influence contemporary debates in Germany. Conclusion This dynamic can be illustrated by controversies surrounding research involving persons who lack decision-making capacity. The article is therefore intended as a reconstruction of discursive developments that enables current research-ethical conflicts (e.g., those concerning research with individuals incapable of providing informed consent) to be situated analytically. Our analysis also contributes to bringing these bioethical orientations into clearer dialogue by specifying their respective historical and normative foundations.
Die Reduktion psychiatrischer Zwangsmaßnahmen wie mechanischer Fixierung und Isolierung ist ein zentrales Ziel einer freiheits- und menschenrechtsorientierten Versorgung. Sinkende Zahlen formeller Maßnahmen belegen jedoch nicht für sich allein, dass auch die gesamte freiheits- und druckbezogene Belastung – einschließlich informellen Drucks und subjektiv erlebten Zwangs – abnimmt. Diese konzeptionell-normative Originalarbeit untersucht deshalb mögliche Substitutionseffekte in der akutstationären Erwachsenenpsychiatrie in Deutschland. Sie unterscheidet eine geeignete weniger restriktive Alternative von einer substitutionsverdächtigen Ersatzhandlung, einer Risikoexternalisierung und einer dokumentarischen Reklassifikation oder Untererfassung. Ein empirisch nachgewiesener Substitutionseffekt ist davon als gesonderter Nachweisstatus abzugrenzen. Die Argumentation verbindet medizinethische Maßstäbe mit theoretisch plausiblen Mechanismen und drei kompositen Szenarien. Sedierende Akutmedikation wird dabei nicht pauschal als Zwang bewertet, sondern nach Indikation, Zweck, Einwilligung, tatsächlichen Wahlmöglichkeiten, Wirkung, Intensität, Dauer, Reversibilität, Alternativen und Kontrolle geprüft. Abschließend wird ein unvalidierter Reflexions- und Lernrahmen für Fallprüfung und Qualitätsentwicklung vorgeschlagen. Er verknüpft Daten zu formellen Maßnahmen mit klinischem Kontext, Patientenerleben, Folgeereignissen und Organisationsbedingungen. Der Rahmen soll mögliche Substitutionseffekte systematisch prüfbar machen; er behauptet weder deren Häufigkeit noch einen allgemeinen Kausalzusammenhang.
German right-to-die organisations have been legally operating since the 1980s, much like in Switzerland, although this is often not widely known by the public. It is noteworthy that there is little discussion specifically about the volunteer members of these organisations, despite their work offering a unique perspective on assisted suicide. The aim of this study was therefore to explore, through a qualitative interview study, the individual motivations and personal expectations of members of German right-to-die organisations and thereby contribute to the broader ethical, societal, and political debate on assisted suicide. This project was implemented through qualitative interviews conducted with active volunteer members of German right-to-die organisations, followed by a structuring qualitative content analysis based on Mayring’s approach. Thirteen interviews were conducted. Within the framework of qualitative content analysis, the data were coded by assigning text segments to predetermined categories, while additional categories were developed inductively during the analysis. Our interviews revealed that negative experiences with end-of-life circumstances were a key motivation for engaging in voluntary work. Participants mentioned particularly dramatic circumstances surrounding the death of close relatives. Additionally, many participants noted that altruistic motivations were a significant driving factor for their involvement. Physicians state that ensuring optimal and comprehensive patient care is a relevant aspect for their engagement. Prevention of brutal suicides was also mentioned as a further motive. Regarding expectations, most participants expressed dissatisfaction with the current political discourse in Germany, advocating for a more natural and open approach to discussions surrounding assisted suicide and the overall culture of death. This study shows that engagement in right-to-die organisations is shaped by recurring patterns, particularly negative end-of-life experiences, altruistic motives, and, among physicians, professional responsibility. A key finding is the perceived paradoxical effect of suicide prevention, as the availability of assisted suicide may reduce immediate suicidal pressure and prevent more violent deaths. In addition, participants highlighted persistent societal taboos and a lack of alignment between political regulation and practical experience. These findings underline the importance of incorporating experiential perspectives into ongoing debates on assisted suicide.
