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Dive into the research topics where Hans-Martin Sass is active.

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Featured researches published by Hans-Martin Sass.


Journal of Pain and Symptom Management | 1998

End-of-Life Decisions and Advance Directives in Palliative Care: A Cross-Cultural Survey of Patients and Health-Care Professionals

Raymond Voltz; Akira Akabayashi; Carol Reese; Gen Ohi; Hans-Martin Sass

In order to explore possible differences in the scope of end-of-life decisions and attitudes toward advance directives (AD) in palliative care, we conducted a survey of 159 patients in palliative care institutions and 93 health-care professionals experienced in palliative care in the United States, Germany, and Japan. Giving an AD in this clinical setting was considered important by patients and professionals. The prevalence of a formal written AD was 79% in the United States, 18% in Germany, and 9% in Japan. In Japan, there was a high prevalence of entrusting all decisions to the family (known as omakase). More than 80% of the patients had negative feelings toward their future decisions in the United States and Germany, in contrast to only 45% in Japan. Although favored by the professionals, there were no specific instruments for obtaining ADs. In Germany and Japan, some patients had given an informal AD. As a pilot content validity step, survey results were used to derive a checklist for content and procedural aspects in end-of-life decision-making. This checklist may provide the basis for developing an instrument to guide physicians, especially non-palliative care specialists, in communication with their patients and their families in this difficult clinical situation.


Journal of Pain and Symptom Management | 1998

Original ArticleEnd-of-Life Decisions and Advance Directives in Palliative Care: A Cross-Cultural Survey of Patients and Health-Care Professionals☆

Raymond Voltz; Akira Akabayashi; Carol Reese; Gen Ohi; Hans-Martin Sass

In order to explore possible differences in the scope of end-of-life decisions and attitudes toward advance directives (AD) in palliative care, we conducted a survey of 159 patients in palliative care institutions and 93 health-care professionals experienced in palliative care in the United States, Germany, and Japan. Giving an AD in this clinical setting was considered important by patients and professionals. The prevalence of a formal written AD was 79% in the United States, 18% in Germany, and 9% in Japan. In Japan, there was a high prevalence of entrusting all decisions to the family (known as omakase). More than 80% of the patients had negative feelings toward their future decisions in the United States and Germany, in contrast to only 45% in Japan. Although favored by the professionals, there were no specific instruments for obtaining ADs. In Germany and Japan, some patients had given an informal AD. As a pilot content validity step, survey results were used to derive a checklist for content and procedural aspects in end-of-life decision-making. This checklist may provide the basis for developing an instrument to guide physicians, especially non-palliative care specialists, in communication with their patients and their families in this difficult clinical situation.


Kennedy Institute of Ethics Journal | 2008

Fritz Jahr's 1927 Concept of Bioethics

Hans-Martin Sass

In 1927, Fritz Jahr, a Protestant pastor, philosopher, and educator in Halle an der Saale, published an article entitled “Bio-Ethics: A Review of the Ethical Relationships of Humans to Animals and Plants” and proposed a “Bioethical Imperative,” extending Kant’s moral imperative to all forms of life. Reviewing new physiological knowledge of his times and moral challenges associated with the development of secular and pluralistic societies, Jahr redefines moral obligations towards human and nonhuman forms of life, outlining the concept of bioethics as an academic discipline, principle, and virtue. Although he had no immediate long-lasting influence during politically and morally turbulent times, his argument that new science and technology requires new ethical and philosophical reflection and resolve may contribute toward clarification of terminology and of normative and practical visions of bioethics, including understanding of the geoethical dimensions of bioethics.


Kennedy Institute of Ethics Journal | 1993

Using Stories to Assess Values and Establish Medical Directives

Rita Kielstein; Hans-Martin Sass

While still developing in Germany, a consensus has emerged in the United States on the use of advance directives for guiding future medical decision making. This article outlines three phases in the evolution of advance directive forms—the legal phase, the checklist phase, and the story phase. The story-based approach is discussed as the best method for assessing patient values and incorporating them into advance directives, and a story-based advance directive form, which has been developed and tested during the past two years, is presented.


Palliative Medicine | 1997

Organization and patients' perception of palliative care: a crosscultural comparison:

Raymond Voltz; Akira Akabayashi; Carol Reese; Gen Ohi; Hans-Martin Sass

The hospice model of care for patients with advanced diseases exists in almost all industrialized countries. To date, there have been no international or crosscultural comparisons of the organization and patient outcomes associated with hospice services in different parts of the world. This survey evaluated 159 patients in the USA, Germany and Japan. There were differences between countries in the time of first contact, who recommended palliative care first, the underlying diagnoses, the location of patients, and how consent for hospice care was obtained. Across all countries, there were similar levels of comfort and satisfaction with care. We conclude that the hospice philosophy addresses the basic needs of dying patients which are independent of cultural background, but may be adapted to very different cultures.


Bundesgesundheitsblatt-gesundheitsforschung-gesundheitsschutz | 2008

Public-Health-Ethik ist Partnerschaftsethik

Hans-Martin Sass

ZusammenfassungSicherung und Sicherstellung der Gesundheit von Bürgern sind zentrale staatliche Verpflichtungen und kulturelle wie ethische Aufgaben, die ohne Partnerschaft mit privaten und öffentlichen Serviceanbietern und mit gesundheitsmündigen Bürgern ordnungspolitisch und ordnungsethisch weder begründbar noch erfolgreich sind. Auftrag, Strategie, Taktik und Ethik von Public Health können daher nur im Rahmen einer Partnerschaftsethik entwickelt, durchgeführt und bewertet werden. Prinzipienkataloge aus Bioethik und Klinischer Ethik eignen sich nicht zum Ausmessen des ethischen Rahmens, des genuinen Auftrages und der besonderen Konflikt- und Risikosituationen von Public Health. Das SEMPER-Modell versucht die Bedeutung der 6 Prinzipien Sicherheit, Erziehung, Minimax, Partnerschaft, Ergebnisorientierung, Review im Einzelnen und in ihrer Interaktion untereinander als Rahmen von Public Health in der Sicherung und Förderung von Gesundheit und Lebensqualität zu verdeutlichen.AbstractSecuring and safeguarding the health of citizens are preeminent governmental obligations and cultural as well as ethical responsibilities. Public health needs to be developed, implemented and reviewed in partnership with existing private and public market forces and with health-literate citizens; mission, strategy, tactics and ethics of public health depend on partnership ethics. Traditional sets of principles in bioethics, research ethics, or clinical ethics are not useful to delineate the framework, the mandate, and the specific conflicts and risks in public health. The SEMPER model exemplifies the role of the principles of safety, education, minimax, partnership, efficiency, review and their interactions for public health in securing and promoting health and quality of life.


Archive | 1991

Differentialethik und Psychiatrie

Hans-Martin Sass

Werte wandeln sich im Laufe der Geschichte; sie erscheinen auch in den verschiedenen Kulturkreisen in unterschiedlichem Gewand und unterschiedlicher Zuordnung. Wertbegrundungen hangen ab von internen Faktoren der jeweiligen Orientierungssysteme, in denen sie vorkommen. Je stabiler jedoch die Szenarien sind, in denen wertbezogenes Handeln gefordert wird, um so unabhangiger ist der Bedarf an Wertanwendung und Wertintegration in das Szenarium von kulturellen und historischen Veranderungen und von Wertbegrundungsstreitereien. Das gilt insbesondere auch fur solche Szenarien, die von dem Baseler Philosophen und Psychiater Karl Jaspers als Grenzsituationen beschrieben wurden. Wahnsinn und Irrsinn, aber auch die Grenzfalle auf dem Gebiet zwischen Irrsinn und Genialitat, zwischen Gesundheit und Krankheit, neurologischer Normalitat und Abnormalitat gehoren hierher. Von der Schizophrenie bis zum Liebeskummer, von der Depression und der Fremdgefahrdung bis zur Autoaggression reicht das Arsenal dessen, mit dem die Psychiatrie zu tun hat. Bei der Diskussion um die Ethik in der Psychiatrie kann es sich also nicht darum handeln, ethische Werte nachtraglich in einen ansonsten ethikfreien Handlungsraum zu transportieren. Das Thema ist also nicht moralische Aufrustung oder Nachrustung fur ein anderweitig vom Experten beherrschtes Gebiet, sondern es geht um etwas so Unsensationelles wie Qualitatskontrolle, ethische Qualitatskontrolle technischer Interventionsexpertise, oder Differentialethik, die ahnlich hohe Differenzierungsleistungen in Analyse, Bewertung, Interventions- und Prognosevorbereitung erbringt, wie wir das von der modernen Differentialdiagnose erwarten.Was die Ethik in der Psychiatrie zu tun hat, ist das Ausmessen ethisch beschreibbarer unterschiedlicher Szenarien der Interaktion zwischen Heilung Suchendem und Helfer oder die konkrete Abwagung von ethischen Risiken, Nutzen und Kosten in einem psychiatrischen Einzelfall.


Archive | 1991

Philosophical Arguments in Accepting Brain Death Criteria

Hans-Martin Sass

One thing people traditionally feared more than death, was being buried alive.The Technisches Museum in Munich and museums all over the world are full of devices used to differentiate the seemingly dead from the really dead, including coffins with ventilation and communication equipment, bells attached to strings, electric bells and phones, and coffin lids which could be opened from the inside. The traditional determination of pulselessness or the arrest of heartbeat and respiration as signs at face value for determining death, and rightly so, were met with personal and public distrust. Stories of medical malpractice in diagnosing death, of confusing it with sleep, of people suffocating in the coffin or unexpectedly rising from the grave are abundant in the literature over the centuries. Some funeral homes in Munich and other places in Germany were called vitae dubiae azilia (havens of doubtful life) and served as repositories for corpses until the process of decomposing was clearly on its way. Resuscitation societies, called Humane Societies, were mushrooming in the eighteenth century, first in Amsterdam, then under royal patronage in London and in many places of the old and the new world (Dagi 1989). The introduction of brain-based criteria for determining death — or better: for determining whether ‘to treat people as if they were dead’ (Dagi 1989, p. 1) — nearly 25 years ago has changed the scenario of scare. The determination of death now seems to be biomedically sufficient and conclusive, risk free, but its bioethical evaluation in individual cases of prolonging or terminating life in the intensive care parameters still do not prevent fear, anxiety, and scare, this time the fear of being kept alive too long. Humane societies encouraging compassionate resuscitation care and intense life support at the end of life are being replaced by Right to Die Societies, discouraging uncompassionate resuscitation care and intensive life support.


Archive | 1988

Comparative Models and Goals for the Regulation of Human Research

Hans-Martin Sass

Life neither is nor ever has been without risk. But, in the process of history, human beings have managed to reduce a part of their riskful dependency on raw nature by building homes, farms, and machines, by healing diseases and developing drugs to treat them, and by establishing networks for the exchange of goods and information, as well as networks of health care, of regulations, and of social and political contracting for mutual benefit. These developments, however, have not completely freed human life from risk. On the other hand, we have decreased our dependency on nature by increasing our dependency on economic, political, regulatory, cultural, and technological networks. The capacities and potential catastrophes of these new networks have created new forms of risk endangering not only our survival, but also that which each of us, according to his or her preferences, would consider to be a good life.


Archive | 2010

Advance Directives: Balancing Patient’s Self-Determination with Professional Paternalism

Hans-Martin Sass; Arnd T. May

Anticipatory planning for psychiatric care and treatment differs from routine end-of-life care planning. Validity of wishes and directives is difficult to establish and to interpret and may change due to the course of the disease. Models of advance care documents include Ulysses Contracts, and community-based or provider-based standards, use of the concept of Precedent Autonomy, and forms of proxy consent. Preparing care documents is a methodological and communicative challenge within an environment of professional paternalism. Narrative forms to elicit patient’s preferences and negotiated contracts are the methods of choice. While more detailed empirical and conceptual research is needed, the classical conflict in professional responsibility to balance the respect for patient’s self-determination with paternalism within a paternalistic model most likely will remain, calling for practical and compassionate reasoning and care.

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Rita Kielstein

Otto-von-Guericke University Magdeburg

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Arnd T. May

Ruhr University Bochum

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Raymond Voltz

Ludwig Maximilian University of Munich

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