In this essay, I discuss three readings of Descartes’ Meditations. According to the first reading, “I exist” is for Descartes the foundation of our knowledge. This reading is dismissed on the grounds that, in his view, as long as God’s existence is not proven there is a good reason to doubt this proposition. Proponents of the second reading claim that there are two kinds of Cartesian knowledge: perfect and imperfect knowledge. The meditator has imperfect knowledge of “I exist” before God’s existence is proven. Subsequently, she acquires perfect knowledge of various metaphysical theorems. This reading is repudiated, too. I argue for a third reading, according to which “I think” – and not “I exist” – is the foundation of our knowledge.
The article deals with concepts of disease in a historical perspective. The aim is to show that every medical concept of disease is based in a historically specific form on extra-medical ideas of human wealth and happiness. The focus is on the analysis of social consequences of concepts of disease and illness. The social interactions triggered by their attribution and the following social dynamics will be developed from the perspective of a disease concept in historical change using the example of ‚lepraʻ as well as from the perspective of institutionalized inpatient health care in hospitals.
An injection for two million euros, an antihypertensive for less than one cent per tablet: drug prices differ extremely and therefore cause controversy. The article explains how these price differences come about. It describes a historically grown, internationally accepted system of pricing that leads to temporarily high prices by securing market exclusivity, but in the long run ensures a cost-effective supply of medicines globally. However, this presupposes solvent social systems. This in turn puts economically weaker countries at a disadvantage when it comes to access to innovative and high-priced medicines. But in the future, the disease patterns in developing countries will converge with those in industrialised countries. As a result, the relevance of widely used, now low-cost innovations such as cardiovascular drugs will also increase.
Expectations of modern medicine are high. Its offers appear correspondingly diverse and tempting. With increasing age, however, the questions become more pressing: Should everything really be done to preserve life for as long as possible? Health care planning for the last phase of life, which is refinanced by the statutory health insurance funds, offers beneficiaries a tailored range of advice. A systemic approach to counseling is essential if individual needs are to be met, thereby discouraging a narrowing of the focus to medico-legal aspects.
The Pharmaceutical Market Restructuring Act (AMNOG) is enacted since the beginning of 2011. It regulates the price of patent-protected drugs seeking access to the German market. On the one hand, the law aims to gain control over the enormous price increases in the area of drug innovations for health insurance funds, and on the other hand, to provide incentives for innovativeness and avoiding cuts in provision of medical care. On the 10th anniversary of the law, its actual normative-ethical premises and objectives were examined; whether these desired results were achieved, and whether there have been starting points for criticism or potential for improvement. The „common good“ and innovativeness are the central normative valuation criteria.
The right to health, understood as comprehensive entitlements and aims that widely transcend medicine, is safeguarded institutionally in many ways. Primarily, states have the obligation to respect, protect and fulfil the human rights. Their activities are complemented by various UN-organisations, especially the WHO, and non-governmental organisations. Moreover, the private sector and informal institutions – such as social capital and health identity – can strengthen or weaken the human right to health.
The concept of illness in health insurance law is broad and is neither intended nor used in practice for limiting services from the perspective of economic efficiency. Limitation and control of services are effected by explicit exclusions and implicit specifications, which influence the scope of services provided and arranged by physicians. In the health insurance system, unlike in the context of private medical treatment, not every physician is allowed to provide every service, quality must be documented, and the remuneration system works against an expansion of services.
The 124th German Congress of Physicians held in May 2021 decided to delete § 16 S. 3 MBO. The Congress gave as reason for the deletion the unconstitutionality of the clause. This article will show that, although the reasons presented by the Congress are insufficient to justify its claim, § 16 S. 3 MBO is still likely to be formally unconstitutional due to the violation of the principle of legal reservations. In the near future it might prompt all German states to remove the prohibition on physician-assisted suicide from the state physician professional code. If this does happen, the core argument of the judgment of BVerfG against the constitutionality of § 217 StGB will no longer hold and leave room for its possible constitutional interpretation. Consequently, the legislature would not need to develop a new protection concept with regard to § 217 StGB, i.e., Section 217 of the German Criminal Code.
It might be a big burden for informal caregivers when a person with dementia is hospitalized. Clinical employees report, that informal caregivers are sometimes more difficult than the patients themselves. In this review options of good communication are discussed, also with focus on good intercultural communication. Based on clinical case studies, particularly challenging situations are being described and analysed in order to show how difficult cases can be solved.
Many persons with dementia spend their last phase of life in a nursing home. The Zurich Life and Death with Advanced Dementia (ZULIDAD) study therefore investigated the situation of Swiss nursing home residents based on a large routine care dataset. Additionally, 126 nursing home residents with advanced dementia in Zurich were studied for three years or until their deaths. The ZULIDAD Round Table consisting of family members, experts and researchers developed as part of the project a guide on „The end of life with dementia“.