Giovanni Rubeis

• Professor
• Head of the Division Biomedical and Public Health Ethics at Karl Landsteiner University of Health Sciences

Background Internet and mobile-based interventions (IMIs) for mental disorders are seen by some authors as a step forward to narrow the treatment gap in mental health; however, especially in Germany professionals voice ethical concerns against the implementation of IMIs. The fact that there is broad evidence in favor of IMIs and that IMIs have alre...

E-mental health applications (apps) are an increasingly important factor for the treatment of depression. To assess the risks and benefits for patients, an in-depth ethical analysis is necessary. The objective of this paper is to determine the ethical implications of app-based treatment for depression. An evidence-based ethical analysis was conduct...

Zusammenfassung Ziel der Studie Der Einsatz von Internet- und mobilgestützten Interventionen (IMIs) wird als Empowerment von PatientInnen sowie als Verbesserung des Zugangs zu Versorgungsangeboten beschrieben. Die ethischen Risiken für spezifische Patientengruppen werden nur selten diskutiert. Ziel der Studie ist die Verortung der Patientengruppen,...

The concept of intelligent health (iHealth) in mental healthcare integrates artificial intelligence (AI) and Big Data analytics. This article is an attempt to outline ethical aspects linked to iHealth by focussing on three crucial elements that have been defined in the literature: self-monitoring, ecological momentary assessment (EMA), and data min...

The nursing gaze, that is the specific ways of observing the patient in nursing practice, has been the object of ethical debates for decades. It has been argued that the specific feature of observing patients in nursing is the stereoscopic vision that allows nurses to see the patient at the same time as a subject and a body. However, with the incre...

AgeTech refers to a growing sector that is advancing the use of technologies, such as information and communication technologies (ICTs), mobile technologies, robotics, wearables and smart home systems to enhance the lives of older adults. Although AgeTech can be seen as an opportunity for empowering older people and enhance their overall quality of...

Definition of the problem Biomedical research based on big data offers immense benefits. Large multisite research that integrates large amounts of personal health data, especially genomic and genetic data, might contribute to a more personalized medicine. This type of research requires the transfer and storage of highly sensitive data, which raises...

In this chapter, I analyze the impact of MAI on environments, i.e. spaces that we work, live, and act in. My basic assumption is that MAI will transform the material (technical infrastructure and hardware) and immaterial aspects (networks of practices and relationships, behaviors and rules) of these spaces. The background for my analysis the concep...

This chapter gives a short overview of the history of MAI and describes its crucial contemporary applications. The aim is not to give a complete list of technologies, but to highlight the main areas of application of MAI and to focus on its transformative power. In this chapter, I explain some of the fundamental concepts in MAI and discuss some maj...

In this closing chapter, I summarize my main results, but not in the form of narrative conclusion. Rather, I define seven lessons for the present that can be derived from the ethical analysis provided in the previous chapters. These lessons serve as a compass that may help to navigate the impact of MAI on practices, relationships, and environments...

This chapter outlines basic concepts in medical ethics and data ethics. It aims to provide some kind of orientation regarding the complex issues, approaches, and concepts within these fields. I introduce the epistemic lenses of my conceptual approach to the ethics of MAI. This approach mainly rests on critical theory and critical data studies. I al...

In this chapter, I analyze the impact of MAI on relationships as well as roles within healthcare. I identify three crucial relationships, the therapeutic relationships between doctors and patient, the nursing relationship, and the therapeutic alliance between therapists and patients in mental health. The crucial assumption is that MAI is an artific...

In this chapter, I explore the concept of smart data practices, i.e. collecting and operationalizing data by using MAI. The underlying assumption is that epistemic practices of health professionals shape their patient-directed actions and interactions with the patient. Since MAI transforms epistemic practices into smart data practices, this also im...

In this chapter, I revisit some of the most influential definitions of AI from the last decades. No single definition of AI has been agreed upon so far and I do not aim to come up with a concluding definition. My aim is to better understand what AI entails, what it is supposed to be and do, by examining existing definitions. This enables a better u...

Zusammenfassung Die Medizinethik sieht sich zunehmend mit Herausforderungen konfrontiert, die sich aus gesellschaftlichen Machtasymmetrien und epistemischen Ungerechtigkeiten ergeben. Dabei fehlen der Medizinethik die epistemischen Linsen, um diese gesellschaftlichen Kontextfaktoren ärztlichen Handelns analysieren zu können. Um diesen Herausforderu...

Ambient Assisted Living (AAL) refers to technologies that track daily activities of persons in need of care to enhance their autonomy and minimise their need for assistance. New technological developments show an increasing effort to integrate automated emotion recognition and regulation (ERR) into AAL systems. These technologies aim to recognise e...

BACKGROUND Smartphone health apps (mHealth apps) have gained significant popularity recently. mHealth apps can address healthcare disparities and enhance access to healthcare services in low-resource countries. With its vast and diverse population, India presents a unique context for studying the landscape of mHealth apps. However, only a few studi...

Background Smartphone mobile health (mHealth) apps have the potential to enhance access to health care services and address health care disparities, especially in low-resource settings. However, when developed without attention to equity and inclusivity, mHealth apps can also exacerbate health disparities. Understanding and creating solutions for t...

Zusammenfassung Ziel der Arbeit Entscheidungen über Reanimationsversuche (RV) müssen die Chancen auf Überleben gegen die Aussichten auf zusätzliches Leid abwägen. Für Pflegeheimbewohner soll die Basis dieser Abwägung auf Grundlage der im Deutschen Reanimationsregister verfügbaren Endpunkte verbreitert werden. Methodik Retrospektive Auswertung präho...

Digital health technologies transform practices, roles, and relationships in medicine. New possibilities for a ubiquitous and constant data collection and the processing of data in real-time enable more personalized health services. These technologies might also allow users to actively participate in health practices, thus potentially changing the...

Digital Twins are discussed as the new frontier of precision medicine. Using Artificial Intelligence (AI)-technologies, a virtual model of a patient’s organ, physiological structure, or whole body is built from individual health data. This virtual model can be used for drug testing, predictive analysis and risk assessment, disease modelling, or lif...

Pluralism has become the defining characteristic of many modern societies. Not only a plurality of individual and social claims and activities gain impacts on societal life. A creative pluralism of institutions and their norms profoundly shape our moral commitments and character – notably the family, the market, the media, and systems of law, relig...

Fragestellung: Notfalleinsätze und Krankenhauszuweisungen aus Pflegeeinrichtungen sind nicht immer medizinisch indiziert und entsprechen teilweise nicht dem Willen der Bewohner. Ein Grund für potenziell vermeidbare Einsätze kann in strukturell begründeten Handlungsunsicherheiten der Pflegefachpersonen liegen. Hier setzt das Projekt NOVELLE (FKZ: 01...

AAL encompasses smart home technologies that are installed in the personal living environment in order to support older, disabled, as well as chronically ill people with the goal of delaying or reducing their need for nursing care in a care facility. Artificial intelligence (AI) is seen as an important tool for assisting the target group in their d...

Background In nursing homes, residents’ relatives represent important sources of support for nurses. However, in the heightened stress of emergency situations, interaction between nurses and relatives can raise ethical challenges. Research objectives The present analysis aimed at elaborating a typology of nurses’ experience of ethical support and...

AgeTech involves the use of emerging technologies to support the health, well-being and independent living of older adults. In this paper we focus on how AgeTech based on artificial intelligence (AI) may better support older adults to remain in their own living environment for longer, provide social connectedness, support wellbeing and mental healt...

Eine beträchtliche Anzahl an Notfalleinsätzen und Krankenhauszuweisungen bei Pflegeheimbewohner*innen wird als vermeidbar eingestuft und stellt eine unnötige Belastung oder Gefährdung für die Bewohner*innen dar. Ein Grund für diese unnötigen Einsätze liegt häufig in Handlungsunsicherheiten der verantwortlichen Pflegefachpersonen. Im Projekt NOVELLE...

Hintergrund und Stand (inter)nationaler Forschung: Notfallsituationen in Pflegeeinrichtungen führen häufig zu unnötigen Krankenhauszuweisungen und entsprechen oft nicht den Behandlungswünschen von Bewohnern. Das Notfallmanagement wird erschwert durch strukturelle Bedingungen in den Pflegeeinrichtungen, fehlende Patientenverfügungen und herausforder...

Introduction: “Democratizing” artificial intelligence (AI) in medicine and healthcare is a vague term that encompasses various meanings, issues, and visions. This article maps the ways this term is used in discourses on AI in medicine and healthcare and uses this map for a normative reflection on how to direct AI in medicine and healthcare towards...

Open Access verfügbar auf: https://www.vr-elibrary.de/doi/book/10.14220/9783737014793 Digitale Technologien transformieren Praktiken und Strukturen im Pflegebereich. Die ethischen Implikationen dieses Transformationsprozesses sind vielfältig und durch die intersektorale Struktur der Pflege mitbestimmt. Die ethische Analyse und Bewertung einer digi...

Bewohner:innen in Einrichtungen der stationären Langzeitpflege sind zunehmend hochbetagt, multimorbide und nicht selten an Demenz erkrankt. Diese Charakteristika bedingen häufige Rettungsdiensteinsätze in den Einrichtungen mit anschließendem Krankenhaustransport (Bleckwenn et al. 2019; Luiz et al. 2009). Viele dieser Einsätze werden als unnötig ein...

Zusammenfassung Eine beträchtliche Anzahl an Notfalleinsätzen und Krankenhauszuweisungen bei Pflegeheimbewohner:innen wird als vermeidbar eingestuft und stellt eine unnötige Belastung oder Gefährdung für die Bewohner:innen dar. Ein Grund für diese unnötigen Einsätze liegt häufig in Handlungsunsicherheiten der verantwortlichen Pflegefachpersonen. Im...

Background In nursing homes, emergencies often result in unnecessary hospital transfers, which may negatively affect residents’ health. Emergency management in nursing homes is complicated by structural conditions, uncertainties and difficulties communicating with the treating healthcare professionals. The present study investigated the role played...

Background: In nursing homes, emergencies often result in unnecessary hospital transfers, which may negatively affect residents’ health. Emergency management in nursing homes is complicated by structural conditions, uncertainties and difficulties communicating with the treating healthcare professionals. The present study investigated the role playe...

Zusammenfassung Geflüchtete weisen eine hohe Prävalenz an psychischen Störungen auf. Dem hohen Behandlungsbedarf stehen jedoch Barrieren gegenüber, die den Zugang zu psychischen Versorgungsleistungen behindern. Zu den Zugangsbarrieren gehören strukturelle Hürden ebenso wie kulturell differente Haltungen gegenüber psychischer Gesundheit und Krankhei...

Digital technologies have become a crucial factor in nursing. Given the fact that many tasks could also be done by robots or AI systems, the place for the nurse in this scenario is unclear. In what way and to what extent will the implementation of ever more sophisticated technology affect nursing practice? It is the aim of this paper to analyse the...

Wolfgang Reichart (1486-c. 1547) was a humanist and a town physician of Ulm. His work consists of a largely unpublished collection of nearly 600 texts . So far, it has been claimed that this compilation only consists of letters and poems. However, we have found a medical treatise, wherein Reichart discusses a case of impotence, its pathophysiology...

Purpose Internet- and mobile-based interventions (IMIs) are widely used for substance abuse disorders. There is extensive evidence for the efficiency of IMIs. However, there is a lack of research concerning the specific ethical aspects of using IMIs for substance abuse disorders. To the best of our knowledge, our paper is the first detailed ethical...

Wolfgang Reichart (1486-c. 1547) was a humanist and a town physician of Ulm. His work consists of a largely unpublished collection of nearly 600 texts. So far, it has been claimed that this compilation only consists of letters and poems. However, we have found a medical treatise, wherein Reichart discusses a case of impotence, its pathophysiology a...

Gerontechnology based on Artificial Intelligence (AI) is expected to fulfill the promise of the so-called 4p-medicine and enable a predictive, personalized, preventive, and participatory elderly care. Although empirical evidence shows positive health outcomes, commentators are concerned that AI-based gerontechnology could bring along the disruption...

In the summer of 2015, a strong migration movement towards Europe set in. This led to ethical, legal and societal challenges in the medical care for refugees. These included cultural conflicts in medical practice and deficits in the institutional handling of cultural diversity. The book analyzes different challenges and offers possible solutions.

Ethical issues in mental healthcare for refugees entail clinical factors, cultural diversity, and questions of access to mental health services. Clinical factors include the high prevalence of mental disorders and thus high mental health need within the refugee population, the high prevalence of vulnerable patients like minors and women, and the of...

Artificial intelligence (AI) is on the brink of revolutionizing medicine. New tools for dealing with medical data, based on deep learning and state-of-the-art data mining methods, have the potential to change medical practice significantly. The opportunities of AI for biomedical re-search as well as clinical practice are hotly debated. But there is...

Definition of the problemThe options of reproductive medicine are expanding. In some cases, it is unclear whether there is a medical indication for applying procedures of assisted reproduction or whether this application is wish-fulfilling. The distinction between medical indication and wish fulfilment depends on the concept of indication. Thus, th...

Background The belief in witchcraft influenced medical thinking and action in the 16th century. In a hitherto unknown treatise on impotence, the Ulmian town physician Wolfgang Reichart (1486–1547) has rationally explained it by using medical concepts. Materials and methods The treatise was transcribed, translated, and analyzed in terms of its sour...

Background: A newly-found treatise by Wolfgang Reichart (1486-circa 1547), town physician of Ulm, challenges the contemporary view that bewitchment as a cause of impotence defies any natural explanation. Objective: To understand the pathophysiological concept and therapy of erectile dysfunction in Reichart's treatise by examination of his source...

Mit der Digitalisierung der Gesundheitsversorgung werden große Erwartungen verknüpft. So ist in den einschlägigen Debatten etwa von Revolution oder schöpferischer Zerstörung der bisherigen klinischen Praxis die Rede. Manche Kommentatoren erwarten nicht einfach eine partielle Verbesserung der Versorgung durch einen effizienteren Umgang mit Daten ode...

Obwohl Diversität seit einigen Jahren als wichtiges Thema im Gesundheitswesen erkannt ist, gibt es immer noch Kontroversen über dieses Konzept und dessen Umsetzung. So gilt es, u. a. folgende Fragen im Hinblick auf ihre ethischen Implikationen zu diskutieren: 1. Wie kann ein gleichberechtigter Zugang zum Gesundheitswesen für alle garantiert werden,...

E-mental health applications (apps) are an increasingly important factor for the treatment of depression. To assess the risks and benefits for patients, an in-depth ethical analysis is necessary. The objective of this paper is to determine the ethical implications of app-based treatment for depression. An evidence-based ethical analysis was conduct...

Beitrag im Ärzteblatt Baden-Württemberg

Background Internet and mobile-based interventions (IMI) are increasingly being recommended as instruments to reduce the treatment gap for depressive disorders. Given the positive evidence base for the effectiveness of IMI, a further implementation in psychotherapy is to be expected. Thus, an ethical analysis is necessary. Objective The ethical as...

Definition of the problem In March 2019, the German Gemeinsamer Bundesausschuss (G‑BA; Federal Joint Committee) presented the result of the method assessment process on non-invasive prenatal testing (NIPT). The aim of this method assessment process was to decide whether NIPT should become a publicly funded procedure of routine prenatal care. The G‑...

Purpose of the study To discuss the ethical challenges for the therapeutic team when dealing with a young savior sibling as a potential tissue donor. Basic procedures Savior siblings are children that are created to serve a sibling as a donor of umbilical cord blood, bone marrow, or peripheral blood from which hematopoietic stem cells are derived....

Definition of the problem Although mitochondrial replacement techniques have been performed in humans and have been legalized in the UK, three crucial conceptual questions are yet unanswered: (1) Are mitochondrial replacement techniques a germline intervention? (2) Are mitochondrial replacement techniques a medically indicated therapy or an electiv...

The notion of being a burden to others is mostly discussed in the context of care‐intensive diseases or end‐of‐life decisions. But the notion is also crucial in decision‐making at the beginning of life, namely regarding prenatal testing. Ever more sophisticated testing methods, especially non‐invasive prenatal testing (NIPT), allow the detection of...

Surveys of the German public have revealed a high acceptance of social freezing, i.e. oocyte conservation without medical indication. Up to now, there are no investigations available on the experiences and attitudes of health professionals towards social freezing. Between August 2015 and January 2016, we surveyed gynecologists Germany-wide on the t...

Nach deutschem Recht verfolgt der Maßregelvollzug zwei zentrale Ziele: Zum einen die Besserung des Täters, zum anderen die Sicherung der Allgemeinheit. Diese beiden Ziele sollen durch die gesellschaftliche Reintegration, die Straftatfreiheit und die Stabilisierung der Patienten erreicht werden (Bezzel 2010). Legt man das Kriterium der Legalbewährun...

Several scientists as well as physicians propagate methadone as an effective anti-cancer drug. This claim is based on several in vitro-studies and results from the compassionate use of the drug. As a result of the large-scale media coverage, the public is under the impression that methadone is a promising treatment for cancer. In our contribution,...

With the arrival of new methods of genome editing, especially CRISPR/Cas 9, new perspectives on germline interventions have arisen. Supporters of germ line genome editing (GGE) claim that the procedure could be used as a means of disease prevention. As a possible life-saving therapy, it provides benefits that outweigh its risks. Opponents of GGE cl...

Trauma training is a crucial element of medical education in the civilian sector, as well as in the military sector. Its aim is to prepare physicians, medics and nurses for stressful and demanding emergency situations. Training methods include live-tissue training (LTT) on animal models and simulationbased trauma education. For LTT, blast, gunshot...

Casuistry depends on the basic assumption that the casuist method is the ideal way of decision making in medical ethics because of its structural similarity to clinical practice. Our close examination of the basic assumption shows that it overemphasizes the role of building analogies between cases for clinical decision making and that it is incongr...

Telemedicine is a complex field including various applications and target groups. Especially telehealthcare is seen by many as a means to revolutionize medicine. It gives patients the opportunity to take charge of their own health by using self-tracking devices and allows health professionals to treat patients from a distance. To some, this means a...

Interventions in the human germline have been regarded as a red line in genetic engineering up to now. However, with the recent progress in genome editing techniques, first and foremost CRISPR-based methods, the tide seems to be turning. The therapeutic benefits in particular are brought forward as an argument in favor of germline genome editing. A...

The following article aims to shed a light on the role of instrumentalism in John Dewey’s epistemology as well as philosophy of science. Its basic conclusion is that Dewey can be considered an unorthodox realist, following the terminology by Godfrey-Smith , and that his instrumentalist position can be interpreted as a problem-solving approach (Laud...

The executive board of the Academy for Ethics in Medicine (AEM) and two AEM working groups formulated standards and recommendations for clinical ethics consultation in 2010, 2011, and 2013. These guidelines comply with the international standards like those set by the American Society for Bioethics and Humanities. There is no empirical data availab...

It is the aim of this paper to establish the concept of politicized medicine. The starting point is the work by Steger and Schochow on the Closed Venerological Wards in the GDR. Steger and Schochow operate with the concept of politicized medicine, although they do not elaborate it due to their primarily empirical approach. In this paper, the theore...