One thing people traditionally feared more than death, was being buried alive.The Technisches Museum in Munich and museums all over the world are full of devices used to differentiate the seemingly dead from the really dead, including coffins with ventilation and communication equipment, bells attached to strings, electric bells and phones, and coffin lids which could be opened from the inside. The traditional determination of pulselessness or the arrest of heartbeat and respiration as signs at face value for determining death, and rightly so, were met with personal and public distrust. Stories of medical malpractice in diagnosing death, of confusing it with sleep, of people suffocating in the coffin or unexpectedly rising from the grave are abundant in the literature over the centuries. Some funeral homes in Munich and other places in Germany were called vitae dubiae azilia (havens of doubtful life) and served as repositories for corpses until the process of decomposing was clearly on its way. Resuscitation societies, called Humane Societies, were mushrooming in the eighteenth century, first in Amsterdam, then under royal patronage in London and in many places of the old and the new world (Dagi 1989). The introduction of brain-based criteria for determining death — or better: for determining whether ‘to treat people as if they were dead’ (Dagi 1989, p. 1) — nearly 25 years ago has changed the scenario of scare. The determination of death now seems to be biomedically sufficient and conclusive, risk free, but its bioethical evaluation in individual cases of prolonging or terminating life in the intensive care parameters still do not prevent fear, anxiety, and scare, this time the fear of being kept alive too long. Humane societies encouraging compassionate resuscitation care and intense life support at the end of life are being replaced by Right to Die Societies, discouraging uncompassionate resuscitation care and intensive life support.

Medical ethics has developed methods of differential ethics for a more rigid integration of bioethical reasoning into biomedical research. Due to high levels of risk and uncertainty in phase I trials, established principles of medical ethics need a specific assessment in order to provide for better moral design and moral monitoring of trial procedures, a better translation of medical health status data into individual quality of life criteria, and strong support for trust-based cooperation between physician, research team and patient. Existing bioethical questionnaires and detailed methodological research in differential ethics could be improved further.