Suizid und Suizidbeihilfe aus rechtlicher und ethischer Perspektive

Das Bundesverfassungsgericht hat im Jahr 2020 das Verbot der geschäftsmäßigen Beihilfe zur Selbsttötung für verfassungswidrig und nichtig erklärt. Das Gericht leitet aus dem allgemeinen Persönlichkeitsrecht ein Recht auf selbstbestimmtes Sterben ab. Dieses Recht schließe auch die Freiheit ein, sich das Leben zu nehmen sowie hierfür bei Dritten Hilfe zu suchen und Hilfe, soweit sie angeboten wird, auch in Anspruch zu nehmen. Inzwischen liegen einige Regelungsvorschläge und Gesetzesentwürfe vor, die unterschiedliche Konzeptionen einer möglichen zukünftigen Regelung der Suizidbeihilfe verfolgen. Der Suche nach einer neuen Regelung sollte aber aus strafrechtlicher Perspektive stets die Frage nach der Erforderlichkeit einer neuen Regelung vorausgehen. Eine Neuregelung darf sich nicht auf bestimmte Personengruppen, wie beispielsweise Personen mit unheilbarer, tödlicher Erkrankung, beschränken, weil andernfalls das Suizidmotiv bewertet würde. Dieses bringt die besondere Herausforderung mit sich, eine Regelung zu finden, die ohne eine Bewertung des Suizidmotivs die unterschiedlichen Problem- und Bedürfnislagen erfasst und dabei auch in den Blick nimmt, dass die Autonomie des Einzelnen in unterschiedlicher Weise gefährdet sein kann. Der Beitrag nimmt seinen Ausgangspunkt in dem Recht auf Selbsttötung, beleuchtet unterschiedliche Konzepte und diskutiert ihre Vor- und Nachteile, ohne einzelne Gesetzesvorschläge explizit herauszustellen. Hierdurch soll die weitere Debatte um einzelne Aspekte bereichert werden. Zugleich wird dafür geworben, gesetzgeberische Zurückhaltung zu üben.In 2020, the Federal Constitutional Court declared the ban on assisted suicide unconstitutional and invalid. The court derived a right to self-determined dying from the general right of personality. This right also includes the freedom to take one’s own life and to seek help from third parties for this purpose and to make use of help if it is offered. In the meantime, there are several proposals for regulations and draft laws that pursue different concepts of a possible future regulation of assisted suicide. However, from the perspective of criminal law, the search for a new regulation should always be preceded by the question of the necessity of a new regulation. A new regulation must not be limited to certain groups of persons, such as persons with incurable, terminal illnesses, because otherwise the suicide motive would be assessed. This brings with it the particular challenge of finding a regulation that covers the different problem and need situations without assessing the suicide motive and also takes into account that the autonomy of the individual can be endangered in different ways. The article takes its starting point in the right to suicide, sheds light on different concepts, and discusses their advantages and disadvantages without explicitly highlighting individual legislative proposals. This is intended to enrich the further debate with individual aspects. At the same time, it advocates legislative restraint

The reform of guardianship law

Die Betreuungsrechtsreform ist beschlossen! Zum 01.01.2023 tritt sie in Kraft. Das Betreuungsrecht wird in seiner inhaltlichen Ausrichtung nicht völlig neu aufgestellt. Das Spannungsverhältnis zwischen dem Schutz der Person vor einer nicht eigenverantwortlichen Entscheidung und der Selbstbestimmung der Person wird konsequent weitergedacht und die Selbstbestimmung der betroffenen Person gestärkt. Unterstützende Entscheidungsfindung, die Befolgung von Wünschen und die Aufgabe des Begriffs „Wohl“ als Maßstab für das Betreuerhandeln sind einige Beispiele hierfür. Das neue Recht zieht auch Grenzen bei der Befolgung von Wünschen. Nämlich dann, wenn mit ihnen die Gefahr einer erheblichen Schädigung der Person oder ihres Vermögens einhergeht. Der Beitrag stellt zunächst wesentliche Ziele der Reform dar. Hiervon ausgehend werden Schwerpunkte gesetzt, die für die psychiatrische Praxis relevant erscheinen: die Streichung des Worts „Wohl“, die Regelung der Vorsorgevollmacht, Maßnahmen zur stärkeren Beachtung und zur besseren Umsetzung des im Betreuungsrecht zentralen Grundsatzes der Erforderlichkeit. Kritisch wird Stellung bezogen zum neu eingefügten Ehegattenvertretungsrecht. Im Ergebnis bleibt festzustellen, dass im Bereich der Gesundheitssorge und erst recht im Bereich der Zwangsmaßnahmen für die Praxis recht wenig bedeutsame Änderungen eintreten werden. Ob sich das begrüßenswerte Anliegen des Gesetzgebers verwirklicht, Betreuungen durch eine verbesserte Information und Beratung zu sozialen Rechten und Ansprüchen zu vermeiden, wird die Praxis erst noch zeigen müssen. Gleiches gilt sicherlich auch für eine Stärkung der Entscheidungsunterstützung, eine Idee, die ebenfalls zu begrüßen ist, für die die Praxis aber noch nach einem Goldstandard sucht.The reform of the guardianship law has been decided! The reform will come into force on 1 January 2023. The content of the guardianship law will not be completely restructured. The tense relationship between the protection of the person against decisions not made on his or her own responsibility and the self-determination of the person will be consistently further considered and strengthened in favor of the self-determination of the person concerned. Supportive decision making, the consideration of a person’s wishes, the abandonment of the term (and concept of) “well-being” as a measure for guardianship are some examples; however, the new law also sets boundaries in adhering to a person’s wishes. Namely, if they are associated with the risk of significant harm to the person or his or her property. The article first presents the main objectives of the reform. Based on this, the focal points are the deletion of the word “well-being”, the regulation of the proxy power of attorney and measures for greater consideration and better implementation of the principle of the necessity, which is central to the guardianship law. Critical comments are made on the newly introduced spousal representation law and its significance for the psychiatric practice. As a result, it can be stated that there will be hardly any significant changes in healthcare and even less so in the area of coercive measures. It remains to be seen whether the legislator’s welcome concern to avoid guardianship through improved information and counselling on social rights will be achieved in practice. The same certainly applies to the strengthening of supported decision making, the idea of which is also to be welcomed but is still looking for a gold standard for practice

Single-shot autocorrelator for KrF subpicosecond pulses based on two-photon fluorescence of cadmium vapor at X = 508 nm

By excitation of cadmium vapor with a high-peak-power KrF excimer laser pulse, fluorescence of an atomic transition at X = 508 nm is induced by a two-photon ionization process followed by fast recombination. The nonlinear response of the medium is used to develop a simple single-shot autocorrelator for subpicosecond KrF excimer laser pulses operating down to intensities of less than 109W/cm.2 We have measured 360-fs (FWHM) pulses at X = 248 nm with a time resolution of 15 fs

Depositional environments in parts of the Carbondale Formation, western and northern Illinois : Francis Creek Shale and associated strata, and Mazon Creek biota.

Prepared for annual field trip, Coal Geology Division, Geological Society of America, Milwaukee, Wisconsin, Nov. 9-10, 1970.Includes bibliographies

Knowledge and misconceptions on advance directives - results of a citizen survey

Einleitung Vorsorgedokumente wie Patientenverfügung oder Vorsorgevollmacht sind bedeutsame Instrumente der Vorausplanung für Situationen, in denen ein Mensch nicht mehr für sich selbst entscheiden kann. Obwohl immer mehr Bürger:innen in Deutschland solche Dokumente erstellen, ist über ihr Wissen zu Zweck, Arten und Anwendung von Vorsorgedokumenten wenig bekannt. Nach über 10 Jahren seit der gesetzlichen Verankerung der Patientenverfügung soll diese Studie das Wissen von Bürger:innen erfassen und Wissenslücken detektieren. Methoden In der Stadt und im Landkreis Würzburg wurde 2021 eine Querschnittsbefragung von volljährigen Bürger:innen u. a. zu Besitz, Umgang mit und Wissensstand zu Vorsorgedokumenten durchgeführt. Die Rekrutierung erfolgte über Werbeanzeigen und lokale Netzwerke. Ergebnisse Von den 282 Befragten (MAlter = 50 J., zu 2 Drittel weiblich) hatten 43,4 % nach Selbstangabe zumindest ein Vorsorgedokument verfasst. Im Wissenstest wurden im Mittel 22/34 Punkten erreicht. Fragen zur konkreten Anwendung von Vorsorgedokumenten anhand eines Fallbeispiels sowie zu Sterbehilfearten wurden häufig korrekt beantwortet, wohingegen beim Faktenwissen zu den einzelnen Dokumenttypen größere Wissensdefizite bestanden. Objektiv getestetes Wissen und Variablen zum subjektiven Wissensstand korrelieren positiv. Diskussion Die relativ hohe Quote an erstellten Dokumenten in dieser Stichprobe ist Ausdruck ihrer raschen Verbreitung in den letzten Jahren. Das Wissensniveau ist als niedrig einzuschätzen und zeigt Fehlvorstellungen zu Rechten und Pflichten der verfassenden Person sowie der beteiligten Akteure. Das gemessene Wissen der Bürger:innen steht in Diskrepanz zum häufig geäußerten Wunsch, durch informiertes Erstellen von Vorsorgedokumenten ihre Selbstbestimmung zu wahren.Background Advance directives (ADs) such as living wills or healthcare powers of attorney are important tools to anticipate medical treatment decisions when decision-making capacity is lost in the future. Although a rising number of citizens in Germany are creating such documents, little is known about their knowledge of the purpose, types, and use of ADs. After more than 10 years since legislation on ADs came into force, this study intends to measure the objective knowledge of citizens and detect deficits in knowledge. Methods We conducted a cross-sectional quantitative survey of citizens aged 18+ in the city and county of Wuerzburg. The questionnaire included, among other things, possession, experience, and knowledge of ADs. Sampling was conducted via advertising and local networking. Results Of the 282 participants who took part in the survey (Mage = 50 years, 2/3 female), 43.4% reported having created a minimum of one document. In the knowledge test, an average of 22/34 points was achieved. While questions about the specific application of ADs based on a case study were often answered correctly, we found deficits about the single document types. The results in the knowledge test and the variables on the subjective level of knowledge correlate positively. Discussion The relatively high rate of ADs in this sample indicates their rapid dissemination during the past few years in Germany. Overall, the level of knowledge ADs appears to be low, revealing misconceptions about the creator’s and involved people’s rights and obligations. The measured knowledge level contradicts with the frequently expressed desire of citizens to preserve their autonomy by creating ADs for themselves

The association between MPOWER tobacco control policies and adolescent smoking across 36 countries: An ecological study over time (2006–2014)

Objective: To examine associations over time between national tobacco control policies and adolescent smoking prevalence in Europe and Canada. Design: In this ecological study, national tobacco control policies (MPOWER measures, as derived from WHO data) in 36 countries and their changes over time were related to national-level adolescent smoking rates (as derived from the Health Behaviour in School-aged Children study, 2006-2014). MPOWER measures included were: Protecting people from tobacco smoke (P), offering help to quit tobacco use (O), warning about the dangers of tobacco (W), enforcing bans on advertising, promotion and sponsorship (E) and raising taxes on tobacco (R). Results: Across countries, adolescent weekly smoking decreased from 17.7% in 2006 to 11.6% in 2014. It decreased most strongly between 2010 and 2014. Although baseline MPOWER policies were not directly associated with differences in average rates of adolescent smoking between countries, countries with higher baseline smoke-free policies (P) showed faster rates of change in smoking over the time period. Moreover, countries that adopted increasingly strict policies regarding warning labels (W) over time, faced stronger declines over time in adolescent weekly smoking. Conclusion: A decade after the introduction of the WHO MPOWER package, we observed that, in our sample of European countries and Canada, measures targeting social norms around smoking (i.e., smoke-free policies in public places and policies related to warning people about the dangers of tobacco) are most strongly related to declines in adolescent smoking.publishedVersio

"That's just Future Medicine" - a qualitative study on users' experiences of symptom checker apps

Background Symptom checker apps (SCAs) are mobile or online applications for lay people that usually have two main functions: symptom analysis and recommendations. SCAs ask users questions about their symptoms via a chatbot, give a list with possible causes, and provide a recommendation, such as seeing a physician. However, it is unclear whether the actual performance of a SCA corresponds to the users’ experiences. This qualitative study investigates the subjective perspectives of SCA users to close the empirical gap identified in the literature and answers the following main research question: How do individuals (healthy users and patients) experience the usage of SCA, including their attitudes, expectations, motivations, and concerns regarding their SCA use? Methods A qualitative interview study was chosen to clarify the relatively unknown experience of SCA use. Semi-structured qualitative interviews with SCA users were carried out by two researchers in tandem via video call. Qualitative content analysis was selected as methodology for the data analysis. Results Fifteen interviews with SCA users were conducted and seven main categories identified: (1) Attitudes towards findings and recommendations, (2) Communication, (3) Contact with physicians, (4) Expectations (prior to use), (5) Motivations, (6) Risks, and (7) SCA-use for others. Conclusions The aspects identified in the analysis emphasise the specific perspective of SCA users and, at the same time, the immense scope of different experiences. Moreover, the study reveals ethical issues, such as relational aspects, that are often overlooked in debates on mHealth. Both empirical and ethical research is more needed, as the awareness of the subjective experience of those affected is an essential component in the responsible development and implementation of health apps such as SCA. Trial registration German Clinical Trials Register (DRKS): DRKS00022465. 07/08/2020

The association between MPOWER tobacco control policies and adolescent smoking across 36 countries : an ecological study over time (2006–2014)

Objective To examine associations over time between national tobacco control policies and adolescent smoking prevalence in Europe and Canada. Design In this ecological study, national tobacco control policies (MPOWER measures, as derived from WHO data) in 36 countries and their changes over time were related to national-level adolescent smoking rates (as derived from the Health Behaviour in School-aged Children study, 2006-2014). MPOWER measures included were: Protecting people from tobacco smoke (P), offering help to quit tobacco use (O), warning about the dangers of tobacco (W), enforcing bans on advertising, promotion and sponsorship (E) and raising taxes on tobacco (R). Results Across countries, adolescent weekly smoking decreased from 17.7% in 2006 to 11.6% in 2014. It decreased most strongly between 2010 and 2014. Although baseline MPOWER policies were not directly associated with differences in average rates of adolescent smoking between countries, countries with higher baseline smoke-free policies (P) showed faster rates of change in smoking over the time period. Moreover, countries that adopted increasingly strict policies regarding warning labels (W) over time, faced stronger declines over time in adolescent weekly smoking. Conclusion A decade after the introduction of the WHO MPOWER package, we observed that, in our sample of European countries and Canada, measures targeting social norms around smoking (i.e., smoke-free policies in public places and policies related to warning people about the dangers of tobacco) are most strongly related to declines in adolescent smoking.Publisher PDFPeer reviewe

BRASIL E PARAGUAI FRENTE À PANDEMIA DO COVID-19

O presente trabalho aborda o contraste entre as medidas sanitárias de enfrentamento à pandemia do Coronavírus adotadas pelos governos federais do Brasil e Paraguai, dois Estados Partes do MERCOSUL cujos sistemas de saúde são notórios por suas deficiências, mas cujos cômputos de casos de COVID-19 e mortes em sua decorrência afiguram-se de maneira drasticamente antagônica. Tenciona deslindar, sob o prisma do Direito Sanitário, as atuações governamentais emergenciais ocasionadoras da discrepância entre os cenários de espraiamento do novo vírus em ambos os países, bem como aludir, sob a perspectiva do Direito de Integração, os benefícios e/ou malefícios advindos da ausência de cooperação entre membros de um mesmo bloco econômico. Para tanto, realiza breve contextualização do Direito Sanitário em ambas as nações, e compara as medidas de combate ao Coronavírus por elas aplicadas. Utiliza como metodologia pesquisa bibliográfica, consulta a websites governamentais e conteúdo midiático. Conclui que o Paraguai priorizou medidas copiosamente preventivas em detrimento de sujeitar-se ao precário sistema de saúde nacional para remediação, tendo sido a primeira nação sul-americana a executar providências quando a pandemia ainda se atinha aos outros países; o Brasil, em seu turno, preteriu diligências profiláticas ao executá-las apenas quando atingiu um quantum considerável de casos, resultando na sobrecarga do seu já exaurido e deficiente sistema de saúde. Inferiu, ainda, que a busca pela integração, mesmo que mínima, entre os Estados Partes do MERCOSUL durante momento histórico tão sui generis, teria beneficiado as nações e concorrido pela garantia do maior bem jurídico de seus povos: a vida. Palavras-chave: Direito sanitário. Direito de integração. MERCOSUL. Estado de emergência. COVID-19