Informed consent is a central topic in contemporary biomedical ethics. Yet attempts to set defensible and feasible standards for consenting have led to persistent difficulties. In Rethinking Informed Consent in Bioethics, first published in 2007, Neil Manson and Onora O'Neill set debates about informed consent in medicine and research in a fresh light. They show why informed consent cannot be fully specific or fully explicit, and why more specific consent is not always ethically better. They argue that consent needs distinctive communicative transactions, by which other obligations, prohibitions, and rights can be waived or set aside in controlled and specific ways. Their book offers a coherent, wide-ranging and practical account of the role of consent in biomedicine which will be valuable to readers working in a range of areas in bioethics, medicine and law.

Health services research performed over the last three decades has established a body of evidence that undermines a number of the fundamental assumptions of our informed consent laws. Currently there is a divide among the states about what standard prevails in informed consent cases between physician-based states and patient-based states. In physician based states, the courts apply a standard of what information would the reasonable physician disclose to the patient under like or similar circumstances. In patient based states, the courts apply the standard of what information would the objective reasonable patient want under like or similar circumstances. Both standards fail but for different reasons. The physician based standard fails to recognize that there is no true objective standard that physicians follow and in fact there is large practice variation amongst physicians even in the same geographic region. The patient based standard fails to recognize that patient's values and preferences vary widely depending on the individual patient. How a particular patient perceives the medical treatment information based upon their own, lifestyle, values and preferences will dictate what course of treatment to follow. Evidence suggests that informed medical decision making strengthens the therapeutic alliance and improves patient satisfaction. It also reduces in many instances costly surgical interventions. The health services research of Wennberg et al, accompanied with evidence of patient dissatisfaction with current disclosure practices suggests that an overhaul of our current informed consent system is necessary. Shared decision-making, a process that requires both the physician and the patient to engage in a discussion of all relevant information regarding the treatment options, including the risks, benefits and alternatives to treatment, as well as the individual patient's lifestyle, values and preferences, offers a promising alternative to our current system. However, many physicians, lawyers and scholars argue that shared decision-making will consume too much time, money and scarce medical resources in an already overburdened medical system. This article examines these claims and concludes that despite the bureaucratic headaches, the enormous expenditure of financial and human resources, and the need for state by state adoption of new informed consent laws, the long-term benefits of shared decision-making and the use of evidence based decision aids to promote patient understanding of medical information to arrive at informed medical decision making far outweigh the costs for both patients and physicians.

-- Are patients aware of the fact that pharmacological therapies stress the brain in ways which may prevent or postpone symptomatic and functional recovery ? ==================================================== Rethinking Psychiatric D

With increasing urgency, decisions about the digitalized future of healthcare and implementations of new assistive technologies are becoming focal points of societal and scientific debates and addresses large audiences. Decisions require a careful weighing of risks and benefits and contextualizing in-depth ethical analysis with robust empirical data. However, up to now, research on social assistive technologies is mostly dispersed over different academic fields and disciplines. A comprehensive overview on discussions regarding values at stake and ethical assessment of recent developments especially in healthcare is largely missing. This publication initiates an interdisciplinary discourse on ethical, legal and social implications of socially assistive technologies in healthcare. Contributions include perspectives from nursing science, social sciences, philosophy, medical ethics, economics and law to present an – to our knowledge – first and comprehensive overview on different aspects of the use and implementation of socially assistive technologies from an ethical perspective. It combines practically relevant insights and examples from current research and development with ethical analysis to uncover exemplary moral tipping points between promotion of participation or well-being and risks and damages to these values. Healthcare professionals involved in implementation of smart technologies as well as scholars from the field of humanities, nursing and medicine, interested in the discussions on ethics and technology in healthcare, will benefit from this new contribution. The publication is part of the international DigitAs conference "Aging between Participation and Simulation – Ethical Dimensions of Socially Assistive Technologies" held at the Institute of Medical Ethics and History of Medicine (Ruhr University Bochum) from 4 February to 8 February 2019. Within this framework, twelve young scholars were invited to discuss their contributions with renowned experts in the field. The Institute of Medical Ethics and History of Medicine is one of the leading institutes in empirically informed ethical analysis in healthcare and medicine and is a member of the European Association of Centres of Medical Ethics (EACME).

​The goal of this open access book is to develop an approach to clinical health care ethics that is more accessible to, and usable by, health professionals than the now-dominant approaches that focus, for example, on the application of ethical principles. The book elaborates the view that health professionals have the emotional and intellectual resources to discuss and address ethical issues in clinical health care without needing to rely on the expertise of bioethicists. The early chapters review the history of bioethics and explain how academics from outside health care came to dominate the field of health care ethics, both in professional schools and in clinical health care. The middle chapters elaborate a series of concepts, drawn from philosophy and the social sciences, that set the stage for developing a framework that builds upon the individual moral experience of health professionals, that explains the discontinuities between the demands of bioethics and the experience and perceptions of health professionals, and that enables the articulation of a full theory of clinical ethics with clinicians themselves as the foundation. Against that background, the first of three chapters on professional education presents a general framework for teaching clinical ethics; the second discusses how to integrate ethics into formal health care curricula; and the third addresses the opportunities for teaching available in clinical settings. The final chapter, "Empowering Clinicians", brings together the various dimensions of the argument and anticipates potential questions about the framework developed in earlier chapters.