Rethinking Human Embryo Research Policies

It now seems technically feasible to culture human embryos beyond the "fourteen-day limit," which has the potential to increase scientific understanding of human development and perhaps improve infertility treatments. The fourteen-day limit was adopted as a compromise but subsequently has been considered an ethical line. Does it remain relevant in light of technological advances permitting embryo maturation beyond it? Should it be changed and, if so, how and why? What justifications would be necessary to expand the limit, particularly given that doing so would violate some people's moral commitments regarding human embryos? Robust stakeholder engagement preceded adoption of the fourteen-day limit and should arguably be part of efforts to reassess it. Such engagement could also consider the need for enhanced oversight of human embryo research. In the meantime, developing and implementing reliable oversight systems should help foster high-quality research and public confidence in it.

Decisions on the allocation of intensive care resources in the context of the COVID-19 pandemic : Clinical and ethical recommendations of DIVI, DGINA, DGAI, DGIIN, DGNI, DGP, DGP and AEM

In view of the globally evolving coronavirus disease (COVID-19) pandemic, German hospitals rapidly expanded their intensive care capacities. However, it is possible that even with an optimal use of the increased resources, these will not suffice for all patients in need. Therefore, recommendations for the allocation of intensive care resources in the context of the COVID-19 pandemic have been developed by a multidisciplinary group of authors with the support of eight scientific medical societies. The recommendations for procedures and criteria for prioritisations in case of resource scarcity are based on scientific evidence, ethicolegal considerations and practical experience. Medical decisions must always be based on the need and the treatment preferences of the individual patient. In addition to this patient-centred approach, prioritisations in case of resource scarcity require a supraindividual perspective. In such situations, prioritisations should be based on the criterion of clinical prospect of success in order to minimize the number of preventable deaths due to resource scarcity and to avoid discrimination based on age, disabilities or social factors. The assessment of the clinical prospect of success should take into account the severity of the current illness, severe comorbidities and the patient's general health status prior to the current illness.

[Decisions on the allocation of intensive care resources in the context of the COVID-19 pandemic : Clinical and ethical recommendations of DIVI, DGINA, DGAI, DGIIN, DGNI, DGP, DGP and AEM. German version]

In view of the globally evolving Coronavirus Disease (COVID-19) pandemic, German hospitals rapidly expanded their intensive care capacities. However, it is possible that even with an optimal use of the increased resources, these will not suffice for all patients in need. Therefore, recommendations for the allocation of intensive care resources in the context of the COVID-19 pandemic have been developed by a multidisciplinary authors group with support of eight scientific medical societies. The recommendations for procedures and criteria for prioritisations in case of resource scarcity are based on scientific evidence, ethico-legal considerations and practical experience. Medical decisions must always be based on the need and the treatment preferences of the individual patient. In addition to this patient-centred approach, prioritisations in case of resource scarcity require a supra-individual perspective. In such situations, prioritisations should be based on the criterion of clinical prospect of success in order to minimize the number of preventable deaths due to resource scarcity and to avoid discrimination based on age, disabilities or social factors. Assessment of the clinical prospect of success should take into account the severity of the current illness, severe comorbidities and the patient's general health status prior to the current illness.

[Biobanks: in the interests of researchers or donors?]

The establishment and operation of research biobanks are still not regulated by special laws. As a consequence, the acquisition, storage and use of biobank materials and data are only covered by quite general legal regulations. The way in which these rules are to be interpreted in relation to the specific problems of biobanks is rather controversial. The central question revolves around the tense relationship between the right to privacy of the donor and the academic freedom of the researchers. This article gives an overview of the current discussion and suggestions for practice.

[Organ allocation issues in transplantation medicine: legal aspects]

In transplantation medicine there is neither fair organ allocation per se, nor a specific organ distribution required by the German law. The constitution primarily provides a restrictive framework, and it is the parliamentary legislator's task to fill in the details. Following the principle of division of labour, the involvement of medicine in solution finding is permitted and deemed to be justified. Nevertheless, these basic decisions should have been made by the German legislator in much more detail.

Safeguarding donors' personal rights and biobank autonomy in biobank networks: the CRIP privacy regime

Governance, underlying general ICT (Information and Communication Technology) architecture, and workflow of the Central Research Infrastructure for molecular Pathology (CRIP) are discussed as a model enabling biobank networks to form operational "meta biobanks" whilst respecting the donors' privacy, biobank autonomy and confidentiality, and the researchers' needs for appropriate biospecimens and information, as well as confidentiality. Tailored to these needs, CRIP efficiently accelerates and facilitates research with human biospecimens and data.

[Therapeutic and reproductive cloning from a legal point of view]

The German constitution contains no easy answers to the question of whether and under what circumstances an altering of the current embryo protection law might lead to the therapeutic or even reproductive cloning of human beings being allowed. Due to the fact that guiding fundamental research does not exist, the time for a decision has surely not yet come. But should concrete opportunities for therapy based on therapeutic cloning begin to emerge or it become clear that reproductively cloned humans are not genetically disadvantaged when compared with human beings engendered through impregnation (an unrealistic prospect from a present-day perspective), then the legislator himself will have to come to a decision, openly and by taking a balanced account of his social responsibilities. Hiding behind the constitution by, for instance, simply alluding to human dignity will then no longer be an option.

The conflict of understanding the genetic make-up of man and his knowledge of it

The rapid development within the research of the human genome offers a great potential with regard to the diagnosis of genetic diseases but it also bears dangers of misuse. The starting point for avoiding these dangers is the autonomy of the individual, i.e. that the information about his genetic constitution should only be ascertained with his explicit consent. It is the duty of law to protect the individual and his relatives - who might also be concerned - without undermining the right to self-determination. Furthermore, it is discussed whether genetic tests should be limited to "health purposes" only. The problem of this limitation, however, is to define the term "health purposes" particularly when the criterion of "quality of life" is also taken into consideration. In order to assure a responsible handling of the genetic data, genetic analysis and especially the counselling of the subject should be reserved to the medical profession, since only a real understanding of the individual's genetic constitution with all risks and chances will enable him to make an informed and self-determined decision.

[The right not to know, in the German legislation (Part I)]

The right not to know entails being aware of a reality which corresponds to the mental representation one makes of a circumstance through external sensory perceptions or through intellectual actions from which one derives conclusions. The author discusses the different manifestations of this right not to know, from the right not to be informed to a general right of waiver.