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Es gibt Fragen, die sich niemand gern stellt: Wann dürfen wir Sterben zulassen? Wie wahrt man die Würde des Menschen bis zum Schluss? Doch wir müssen Antworten darauf finden - als Individuen und als Gesellschaft. Zwei Drittel aller Menschen in den reichen Ländern sterben nicht mehr unerwartet, sondern absehbar, unter ärztlicher Begleitung. Ralf J. Jox hat die Sterbepraxis auf deutschen Intensivstationen untersucht und eine große Verunsicherung festgestellt. Denn Ärzte und Angehörige müssen über die »Therapiebegrenzung« entscheiden, wenn der Sterbende dies nicht mehr selbst kann. Aus seiner eigenen Erfahrung als Palliativmediziner und auf wissenschaftlicher Grundlage entwickelt Ralf J. Jox Kriterien für ethisch vertretbare Entscheidungen am Sterbebett. Er plädiert für einen intensiven Dialog aller Beteiligten als besten Weg, der Selbstbestimmung des Patienten gerecht zu werden. Eine ethische Fallberatung, mehr Rechtssicherheit, eine bessere Ausbildung in der Sterbebegleitung und vor allem ein gesellschaftlicher Bewusstseinswandel können dazu beitragen, die Entscheidungen am Lebensende erträglicher zu machen. Ralf J. Jox ist Facharzt für Neurologie und Palliativmediziner, erwarb Doktorgrade der Medizin und der Medizinethik (München und Basel) sowie den Mastergrad in Medical Ethics Law (London). Seine medizinethische Dissertation wurde 2009 mit dem Deutschen Studienpreis der Körber-Stiftung ausgezeichnet. Zurzeit leitet er als Akademischer Oberrat den Bereich »Klinische Ethik« an der LMU München.

Physician-assisted dying has been the subject of extensive discussion and legislative activity both in Europe and North America. In this context, dying by voluntary stopping of eating and drinking (VSED) is often proposed, and practiced, as an alternative method of self-determined dying, with medical support for VSED being regarded as ethically and legally justified.In our opinion, this view is flawed. First, we argue that VSED falls within the concept of suicide, albeit with certain unique features (non-invasiveness, initial reversibility, resemblance to the natural dying process). Second, we demonstrate, on the basis of paradigmatic clinical cases, that medically supported VSED is, at least in some instances, tantamount to assisted suicide. This is especially the case if a patient's choice of VSED depends on the physician's assurance to provide medical support.Thus, for many jurisdictions worldwide, medically supported VSED may fall within the legal prohibitions on suicide assistance. Physicians, lawmakers, and societies should discuss specific ways of regulating medical support for VSED in order to provide clear guidance for both patients and healthcare professionals. Please see related article: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0951-0 .

Background Physician-assisted dying has been the subject of extensive discussion and legislative activity both in Europe and North America. In this context, dying by voluntary stopping of eating and drinking (VSED) is often proposed, and practiced, as an alternative method of self-determined dying, with medical support for VSED being regarded as ethically and legally justified. Argument In our opinion, this view is flawed. First, we argue that VSED falls within the concept of suicide, albeit with certain unique features (non-invasiveness, initial reversibility, resemblance to the natural dying process). Second, we demonstrate, on the basis of paradigmatic clinical cases, that medically supported VSED is, at least in some instances, tantamount to assisted suicide. This is especially the case if a patient's choice of VSED depends on the physician's assurance to provide medical support. Conclusion Thus, for many jurisdictions worldwide, medically supported VSED may fall within the legal prohibitions on suicide assistance. Physicians, lawmakers, and societies should discuss specific ways of regulating medical support for VSED in order to provide clear guidance for both patients and healthcare professionals.

Objectives: In November 2015, the German Federal Parliament voted on a new legal regulation regarding assisted suicide. It was decided to amend the German Criminal Code so that any "regular, repetitive offer" (even on a non-profit basis) of assistance in suicide would now be considered a punishable offense. On July 2, 2015, a date which happened to be accompanied by great media interest in that it was the day that the first draft of said law was presented to Parliament, we surveyed 4th year medical students at the Technical University Munich on "physician-assisted suicide," "euthanasia" and "palliative sedation," based on a fictitious case vignette study.

Intro -- Preface -- Contents -- Contributors -- 1: Introduction: Ethical Issues of Neurotechnologies and Artificial Intelligence -- 1.1 Neurotechnology + Artificial Intelligence = Intelligent Neurotechnologies (INT) -- 1.2 Novel Philosophical, Ethical, Legal, and Sociological Approaches to INT: An Overview -- References -- 2: Actions, Agents, and Interfaces -- 2.1 Introduction -- 2.2 BCIs and the Decoding of Movement Intention -- 2.3 Basic and Non-basic Actions -- 2.4 Action, Belief, and Reliability -- 2.5 Action, BCIs, and Identification -- 2.6 Conclusion -- References -- 3: Skilled Action and the Ethics of Brain-Computer Interfaces -- 3.1 Introduction -- 3.2 Do BCI Actions Differ from Ordinary Actions? -- 3.2.1 How Does Acting with a BCI Work? -- 3.2.2 What Is Peculiar About BCIs? -- 3.3 Is Acting with a BCI a Skill Users Can Acquire? -- 3.3.1 What Is Skilled Acting? -- 3.3.2 Learning Effects and BCI Skills -- 3.3.3 Skilled Acting in Action Theory -- 3.4 The Normative Implications of Skilled BCI Use -- 3.5 Conclusion -- References -- 4: Augmenting Autonomy Through Neurotechnological Intervention à la Kant: Paradox or Possibility? -- 4.1 Introduction: The Basis for Augmenting Autonomy Through Brain-Computer Interfacing -- 4.2 Instrumental Autonomy and Moral Autonomy -- 4.3 Advancing from the Enhancement of Instrumental to Moral Autonomy in a Naturalistic Framework -- 4.4 Escaping the Paradox: Extending the Notion of Self-Legislation -- 4.5 Conclusion -- References -- 5: Can BCIs Enlighten the Concept of Agency? A Plea for an Experimental Philosophy of Neurotechnology -- 5.1 Introduction -- 5.2 Neuroadaptation and Symbiotic Technology -- 5.3 Sense of Agency -- 5.4 Experimental Philosophy -- 5.5 Me and My Subconscious Brain States in Action -- 5.6 Conclusion: A Call for ST-Based Experimental Philosophy -- References.