Diskussionsforum medizinische Ethik最新文献

After considering the moral status of the living and of the dead human fetus, the article examines various ethical arguments connected with the use of fetal remains following elective abortion: financial or humanitarian incentives for the termination of pregnancy, conflicts of interest between mother and user, authority over fetal remains and modality of donation and utilization of the fetus. To prevent improper use of fetal remains it is recommended: to separate completely the decisions relating to abortion (first) and to the subsequent use of fetal tissues (second); to obtain explicit informed consent from the mother, making it impossible for her to direct any specific use of the fetal tissues; to base decisions on the method and timing of an abortion on the mother's health care needs alone; to exclude those involved in the process of abortion from any use of the fetus; to protect the anonymity of donor and recipient through an intermediary (tissue bank).

In accordance with Jewish thinking, life ends with the last breath. Analogous to the beginning of life, two leading principles are important for the bioethical assessment of the end of life: the sanctity of life and the fundamental importance of this world. Thus the criteria for the definition of death are the following, which have consequences for the questions of euthanasia, organ-transplantation, autopsies and the status of the dead.

The antiprogestin RU 486 converts the early pregnant uterus by increasing the sensitivity of the myometrium to prostaglandin (PG). These effects of antiprogestin have resulted in the development of nonsurgical procedures to abort embryos based on a combination of RU 486 and different PG-analogues administered vaginally or intramuscularly. RU 486 also has a softening effect on the cervix which may be used as pretreatment in second and third trimester abortions. The effects, mode of action, dangers, and the many other postulated clinical implications (like breast cancer, meningioma, ectopic pregnancy, fetal death in utero, induction of labour, initiation and promotion of lactation, endometrial or ovarian cancers, leukemia, Cushing's syndrome, uterine adenomyosis, acute uremia, leiomyosarcoma, hypertension, etc.) are discussed.

The paper focuses on the high number of annual induced abortions and is discussing alternative ways to cope with this problem. 151 women were interviewed on the day of abortion. 39 women were interviewed with more detail on the psychological consequences of their abortion carried out 7 to 8 years ago. Main topics of the questionnaire in the first group concerned on the background of conflicts arising from pregnancy, on the information provided by physicians and social advisory boards, and on the question under what circumstances abortion could have been avoided. In the second group 50% of the individuals carried out multiple abortions (up to 5 times). In the conversations it was tried to get more detailed informations on the present well-being, on severe life-events which had taken place in the past years history and on the present point of view to the abortion in 1981.

Before discussing the change of legal norms it is necessary to know the actual law. The paper shows the West-German penal code and it's application in respect of the pregnant women, the physician and third persons.

By RU 486 being synthesized (1980) a pharmacological alternative to surgical methods of abortion has been created. Since 1988 Mifepristone is applied for termination of pregnancies under severe control. Major pros and cons in debates about RU 486 in medical publications are analyzed, their relations to central ethical principles being worked out clearly. As consequences of the analysis of arguments the authors formulate four conditions for the use of Mifepristone as method of abortion which should be considered in further research and practice.