Ethical issues in dental education-A cross-sectional study with pre-clinical and clinical dental students.

INTRODUCTION: Although ethics is an indispensable part of dental education, it has not yet played a relevant role in the dental curriculum in Germany. The study aimed at assessing their prior knowledge of ethical aspects, and their expectations of and wishes for ethics course of dental students, preclinical vs. clinical, at the dental school Kiel, Germany by means of a validated questionnaire. METHODS: A descriptive cross-sectional study design was used. The study population consisted of dental students, from pre-clinical (n = 105) and clinical semesters (n = 110). In January 2019, each student completed a validated questionnaire to identify semester-specific ethical teaching content. Besides descriptive analyses, Mann-Whitney U test was used to compare pre-clinical and clinical students. RESULTS: A total of 215 dental students, with a mean age of 25.3 (SD 4.1), participated in the study, of which 150 were female (69.8%) and 65 were male students (30.2%). The results in the areas of 'previous knowledge of ethical issues' and 'expectations and desires in terms of teaching medical ethics' showed similarities and differences between pre-clinical and clinical students. Both groups stated that they need training in ethics. Moreover, especially clinical students recognize that more ethical competence is needed if the first patient contact will start. CONCLUSION: The study indicates that there is a clear need for ethics education. Student awareness of the relevance of ethical competences and the perception of ethical problems increased progressively during the course of their studies. Overall, the study provides good support for the development of specific ethics courses.

Telemedicine in nursing homes: Insights on the social acceptance and ethical acceptability of telemedical consultations.

Introduction: The increasing number of older adults in need of care, the resulting rise in demand for care services and the shortage of nursing staff are major challenges for society. In these situations, the use of telemedicine seems promising - especially in nursing homes when the focus is on rapid support in acute medical cases. However, in addition to the medical and technical potential, the acceptability and usability of the use of telemedical consultations are crucial for a sustainable implementation and acceptance. Our research aims at a holistic identification of socially and ethically relevant parameters for the evaluation of telemedical consultations in nursing homes. Methods: Presentation of the empirical approach of an interdisciplinary cooperation that combines social and ethical research perspectives during an entire research project. Qualitative analysis of social and ethical aspects based on an interview study with care personnel (N = 14) who have experiences with telemedical consultations in nursing homes, as an example of this interdisciplinary collaboration and to show first insights. Results: The results of the interview study show a slightly positive evaluation of the use of telemedical consultations in nursing homes. Six main categories were identified to capture and differentiate ethically and socially relevant perceived benefits and barriers (contact with physicians, general, personnel-related, residents-related, technical, and organizational aspects). Conclusion: The study results allow initial recommendations for the implementation of telemedicine consultations in nursing homes considering socially and ethically relevant aspects. These recommendations can be used to inform medical and technical experts in the field of telemedicine. In addition, the presentation of the interdisciplinary collaboration shows that the close integration of social and ethical aspects in research enables a holistic dimension of the use of telemedicine.

Nazi persecutee and opponent of racial hygiene: The extraordinary life of the "ethnopathologist" Max Kuczynski (1890-1967).

The pathologist Max Kuczynski (1890-1967) gained recognition for his bacteriological research but is also considered the founder of the so-called ethnopathology. As a "non-Aryan," Kuczynski emigrated from Nazi Germany to Peru, where his elder son was later even to become president. However, the circumstances surrounding the end of Kuczynski's career in Germany are hardly known. This article takes this research gap as an opportunity to reconstruct his life, the circumstances of his emigration, and his work in South America. Numerous archival documents serve as sources. In the mid-1920s, Kuczynski developed "ethnic pathology," a new interdisciplinary approach that offered a counter-concept to the increasingly popular racial hygiene in Germany. But his career in Germany ended even before the Nazis came to power in 1933. He was dismissed from the Charité Pathological Institute in October 1932 at the instigation of its new director, Robert Rössle (1876-1956). Personal and financial reasons played a role, but Kuczynski's rejection of racial hygiene may also have been a decisive factor: Rössle himself turned increasingly to questions of racial hygiene in the Third Reich and used the corpses of Nazi victims for his research. It can be shown that the circumstances of Kuczynski's dismissal were already catalyzed by anti-Semitic and eugenic tendencies, which were to unleash themselves radically in Germany only a few months later - and even caught up with him in Peruvian exile.

A shift in psychiatry through AI? Ethical challenges.

The digital transformation has made its way into many areas of society, including medicine. While AI-based systems are widespread in medical disciplines, their use in psychiatry is progressing more slowly. However, they promise to revolutionize psychiatric practice in terms of prevention options, diagnostics, or even therapy. Psychiatry is in the midst of this digital transformation, so the question is no longer "whether" to use technology, but "how" we can use it to achieve goals of progress or improvement. The aim of this article is to argue that this revolution brings not only new opportunities but also new ethical challenges for psychiatry, especially with regard to safety, responsibility, autonomy, or transparency. As an example, the relationship between doctor and patient in psychiatry will be addressed, in which digitization is also leading to ethically relevant changes. Ethical reflection on the use of AI systems offers the opportunity to accompany these changes carefully in order to take advantage of the benefits that this change brings. The focus should therefore always be on balancing what is technically possible with what is ethically necessary.

The recent ethics boom in dentistry-moral fig leaf, fleeting trend or professional awakening?

OBJECTIVES: "Ethics in dentistry" seems to be gaining importance as more and more dental institutions, professional associations and dental schools are addressing ethical issues. The aim of this paper is to highlight this ongoing development and to analyze and evaluate its relevance for future dentistry and the dental profession. MATERIALS AND METHODS: A qualitative analysis of literature and Internet sources served as the methodological basis. Recent trends were first illustrated using striking examples and then compared with the status quo in medicine and the medical profession, where ethics have a long professional tradition. It is discussed to what extent it seems worthwhile to transfer existing structures and initiatives in medicine to dentistry. RESULTS: There is a broad variety of ethical announcements and initiatives in international dentistry (e.g., dental codes of ethics, adjustments to dental licensure regulations, professional publications, textbooks, awards, podcasts). It should be noted that ethical issues arise not only in life-threatening situations, but also in everyday dental practice. Existing ethical structures in medicine can be adapted or provide guidance for education, clinical practice and research. CONCLUSIONS: Teaching ethical competence in dental education, clinical practice and research can make an important contribution to the professionalization of dentists-quite similar to medicine. Furthermore, a broad integration of ethics in dentistry strengthens the public image of dentists. CLINICAL RELEVANCE: Dealing confidently with ethical issues is a key competence for successful work as a dentist-both in practice and in science.

Persecutee in the Third Reich, full professor in the GDR: The communist physician Carl Coutelle (1908-1993) and his post-war career as pathologist.

As an avowed communist, Carl Coutelle was one of the few (future) pathologists persecuted for purely political reasons in the Third Reich. Despite this peculiarity, his life has received little attention. The present article takes the existing research desideratum as an opportunity to elaborate on Coutelle's fate during the Nazi era, but also on his academic rise to the position of full professor at the University of Halle (GDR). The analysis is based on extensive files from various German archives. The article pursues a twofold question: On the one hand, it seems necessary to clarify how Coutelle's life between 1933 and 1945 can be characterized and classified, and on the other hand, it is of interest whether he owed his career in the GDR primarily to scientific merit or to state support. It can be shown that Coutelle's career path reflects the prevailing political power relations: With the beginning of the Third Reich, Coutelle was completely disenfranchised because of his political views; he was forced to emigrate, interrupted his nascent scientific career, and became actively involved in the international anti-fascist resistance. After the war, Coutelle became one of the protagonists of the socialist transformation and denazification of the health care system in the Soviet Occupation Zone. Now his career took the opposite course: Although his research performance was below average compared to other pathologists from the GDR, the avowed communist was appointed full professor - due to state intervention and against the declared will of the faculty in Halle.

Escaping Nazi Germany: Jewish refugee dentists and their post-emigration careers in the United States of America.

This study is the first to examine the collective of dental lecturers and scientists who emigrated from Nazi Germany to the United States of America. We pay special attention to the socio-demographic characteristics, emigration journeys, and further professional development of these individuals in the country of immigration. The paper is based on primary sources from various German, Austrian, and United States archives and a systematic evaluation of the secondary literature on the persons concerned. We identified a total of eighteen male emigrants. The majority of these dentists left the "Greater" German Reich between 1938 and 1941. Thirteen of the eighteen lecturers were able to find a position in American academia, mainly as full professors. Two-thirds of them settled in New York and Illinois. The study concludes that most of the emigrated dentists studied here succeeded in continuing or even expanding their academic careers in the USA, although they usually had to retake their final dental examinations. No other destination country for immigration offered similarly favorable conditions. Not a single dentist decided to remigrate after 1945.

The ideological roots of Nazi eugenics in pathology and its pioneers Martin Staemmler, Ludwig Aschoff, Robert Rössle, and Georg B. Gruber.

This study examines the ideological roots of Nazi eugenics and racial hygiene in the medical field of pathology and its key figures Martin Staemmler (1890-1974), Ludwig Aschoff (1886-1942), Robert Rössle (1876-1956), and Georg B. Gruber (1884-1977). The focus is on their specific approaches to racial hygiene and its legitimization by pathology and its representatives. The study is based primarily on the scientific works and statements of these four pathologists on the content of racial hygiene and the impact of these contributions on Nazi eugenics and its practical implementation in the Third Reich. The paper provides three key findings: (1) Staemmler, Aschoff, Rössle, and Gruber each had a significant impact on the implementation of Nazi eugenics and the legitimization of the Third Reich's health and population policies. (2) They all proclaimed the superiority of the Volksgemeinschaft ('people's community') over the individual and pursued the major objective of ensuring Volksgesundheit ('national health') by preventing the spread of hereditary diseases through sterilizations. (3) The specific relationship to racial hygiene was different for each of the four pathologists: Staemmler had a direct vision of racial hygiene in a national socialist context, Aschoff was committed to the subject long before 1933 and used the Nazi rise to power to reaffirm and expand his position, Rössle and Gruber adopted racial hygiene ideas not until the mid-1930 s, but later radicalized their views and lent additional legitimacy to Nazi eugenics in theory and practice. (4) Albeit to varying degrees, all four pathologists bear some responsibility for the medical crimes that resulted from Nazi eugenics and the related policies. It can be concluded that Staemmler, Aschoff, Rössle, and Gruber made considerable contributions to the theory of Nazi eugenics and provided the much-needed scientific legitimization for the Third Reich's health and population policies.

From Germany to Venezuela: The two careers of the Jewish-born pathologist Rudolf Jaffé (1885-1975).

The pathologist Rudolf Jaffé (1885-1975) is considered one of the most important specialists of his time - even though he had to flee from the Nazis and attempt a professional restart in South America. The article examines the concrete background of his emigration to South America and the factors that enabled Jaffé to establish pathology as a scientific discipline in Venezuela. Various archival documents and materials from the private archives of Jaffé's descendants serve as sources. These documents are supplemented by relevant secondary literature. Jaffé's career can be divided into four phases: (1) Jaffé's broad education, which qualified him for his later work in Venezuela. (2) Jaffé's professional activity at the Senckenberg Institute of Pathology in Frankfurt. (3) His career peak in Germany as head of the Institute of Pathology in Berlin-Moabit, and finally (4) his forced emigration to Venezuela, where he became the doyen of the field of pathology. It can be shown that Jaffé's great scientific success, even after his emigration, was based on three factors: his exceptional personality, his broad, multifaceted training, and the special conditions in Venezuela.

Nazi functionary or oppositionist in disguise? The complex life of the anatomist Enno Freerksen (1910-2001).

Enno Freerksen (1910-2001) is one of the most prominent German anatomists of his time, as evidenced by numerous international awards. His political role in the Third Reich, however, remains controversial. While some authors describe him an avowed National Socialist, Karl-Werner Ratschko recently speculated about a late turn of Freerksen towards political resistance. The present work takes these contradictions as an occasion for a comprehensive source-based analysis of Freerksen's activities in the Third Reich. For the first time, a synoptic evaluation of primary sources from eight different archives is undertaken. The study is supplemented by a systematic re-analysis of all available research contributions on Freerksen. The study demonstrates that Freerksen not only joined numerous Nazi organizations - partly even before Hitler came to power -, but also took on several important functions in the Nazi apparatus and worked on National Socialist research topics (e.g. racial hygiene). It can also be shown that his steep scientific career was closely linked to his political activities. The thesis that Freerksen opposed Nazi ideology towards the end of the war, on the other hand, must be clearly rejected. On the contrary: The sources show Freerksen as a National Socialist polyfunctionary, who did not self-critically reflect on his role in the Third Reich even after 1945.

Identifying the scope of ethical challenges caused by the Ebola epidemic 2014-2016 in West Africa: a qualitative study.

BACKGROUND: The West African Ebola virus epidemic from 2014 to 2016 is unprecedented in its scale, surpassing all previous and subsequent Ebola outbreaks since 1976. This epidemic provoked a humanitarian emergency that extended to different spheres of life, making visible ethical challenges in addition to medical, economic, and social ones. The present article aims to identify and differentiate the scope of ethical issues associated with the Ebola epidemic. METHODS: An online media analysis was performed on articles published from March 2014 to September 2015 in ten preselected academic journals (scientific press) and two online newspapers (lay press). Two methodological approaches were combined: a systematic literature search and a qualitative content analysis. An additional keyword search was conducted on the PubMed database for the period after the end of the Ebola epidemic (2016-2020) to obtain an overview of research dealing with medical ethics due to the epidemic and to compare these results with the identified ethical challenges. RESULTS: A total of 389 articles dealing with the subject fields "Ebola epidemic" and "ethics" were researched. For qualitative content analysis, the time span with the highest article density was selected and a total of 64 articles were included (15 scientific articles, 49 popular articles). Five core ethical challenges of the Ebola epidemic emerged: 1. Responsibility and Accountability, 2. Spillover Effects, 3. Research and Development, 4. Health Communication, and 5. Resource Allocation. Articles in academic journals were dominated by the discussion of normative aspects in the area of "research and development", while newspaper articles focused on aspects of "responsibility and accountability". CONCLUSION: An ethical discussion of the Ebola epidemic requires an examination of as many of the ethical dimensions involved as possible. The presented investigation of the two types of media with regard to the Ebola epidemic offers this possibility of a more comprehensive insight into this diversity as a basis for ethical discussions.

[From Nazi to Hitler Analyst: The Autobiographical Reinterpretations of the Psychiatrist Johann Recktenwald (1882-1964)]. / Vom Nationalsozialisten zum Hitler-Erklärer: Die autobiografischen Umdeutungen des Psychiaters Johann Recktenwald (1882­1964).

AIM OF THE STUDY: The focus of this article is the psychiatrist Johann Recktenwald (1882-1964) who has so far received little attention: acquitted of the charge of "crimes against humanity", he went public in post-war Germany with a neuropsychiatric treatise on Hitler. But is this appearance as a Hitler-critical psychiatrist consistent with the available historical sources? What was Recktenwald's relationship with the Nazi regime, and how did he behave in the "Third Reich" towards the patients entrusted to his care? METHODS: The paper is largely based on documents from various archives, some of which have been evaluated for the first time, and on court records. The latter are supplemented and compared with the writings of Recktenwald and the available secondary literature. RESULTS: During the "Third Reich", Recktenwald served the Nazi regime in many ways, was jointly responsible for numerous patient murders and thus moved into the role of a Nazi perpetrator. After his acquittal in post-war Germany, he endeavored to construct a personal distance to National Socialism by critically examining Hitler's psychopathology, which at the same time served his own exculpation. CONCLUSION: Recktenwald is a particularly impressive example of the efforts of Nazi perpetrators to retrospectively rewrite their own role in the "Third Reich" - and at the same time a reflection of a post-war society that was willing to accept such biographical reinterpretations in order to avoid coming to terms with the Nazi past.

Nazi, collaborator or opponent? The role of the pathologist Robert Rössle in the Third Reich.

For many, Robert Rössle is one of the most important pathologists of the first half of the 20th century. His research in the fields of inflammation, constitution, growth and age, and immunity gave him the status of a pioneer. Because he was not a nominal member of the Nazi Party (NSDAP), Rössle did not have to undergo denazification proceedings and was able to continue his academic career seamlessly after 1945. Only recently, the question of Rössle's actual role in the Third Reich has been raised - in connection with a possible renaming of the Robert-Rössle-Straße in Berlin. Our paper takes this issue as an opportunity to critically examine Rössle's involvement in National Socialism. For this study, all available literature and extensive primary material on Rössle from various archives was reviewed and evaluated with regard to the question posed. The investigations show that Rössle held a number of offices in the administrative apparatus of the Nazi state even though not being a party member. They gave him access to high-ranking representatives and most likely also knowledge about medical crimes. Rössle researched and published on hereditary biology and racial hygiene issues, thus supporting the ideology of the Nazi State. Robert Rössle must be regarded as an early proponent of racial hygiene, political collaborator and profiteer of the Third Reich. However, it remains unclear whether he was directly involved in human experiments. There is no evidence that he critically distanced himself from his role in the Third Reich after 1945.

From unskilled worker to full professor: The eventful life and career of the Jewish pathologist Herman Medak (1914-1991).

The Jewish pathologist Herman Medak (1914-1991) went down in medical history as a pioneer in the early detection of oral carcinomas. As a longtime full professor of oral pathology at the University of Illinois, he influenced several generations of students and young researchers. His many experimental studies attracted special attention, as did his "Atlas of Oral Cytology" (1970). Largely unknown, however, is the fact that the Viennese-born scientist had to flee from the Nazi regime immediately before his medical state examination and thus arrived in the United States without a qualifying professional degree. This article attempts to fill the existing research gaps and to reconstruct Medak's life and work. It sheds light on Medak's years of study in Vienna, his forced emigration from Austria, his restart in the U.S. and his path to becoming a full professor of oral pathology. It also addresses the question of why Medak remained in Chicago until the end of his life and how the University of Vienna later dealt with its expelled students. The analysis is based on a large number of documents from archives in Austria and the U.S., but also on transcripts and other material from the private collection of the Medak family. These documents were supplemented and compared with the relevant secondary literature. It can be shown that Medak had to overcome considerable setbacks not only in Vienna, but also in the U.S., before he got on the road to professional success. Five factors ultimately proved to be career-enhancing: the Nimbus of the "Vienna School", Medak's unconditional striving for education, his deliberate specialization in oral pathology, his early international contacts and his willingness to adapt and acculturate. Like most other displaced scholars, Medak was widely ignored in postwar Austria. Today, the University of Vienna maintains an online memorial book that also provides information about Medak - albeit still rudimentary.

[The pathologist Hans Klein (1912-1984) : Autopsy of his role in the "Third Reich"]. / Der Pathologe Hans Klein (1912­1984) : Obduktion seiner Rolle im "Dritten Reich".

The role of pathologist Hans Klein during the National Socialist era and his career in post-war Germany have hardly received systematic attention. During World War II, Hans Klein worked in two medical institutions, where he collaborated with individuals who were significantly involved in Nazi crimes. Klein's participation initially extended mainly to his work as an employed pathologist at the Rudolf Virchow Hospital in Berlin. There he was introduced to autopsy practices in the context of the children's euthanasia programme and autopsies of victims of medical experiments. Later, a shift in his activities is noticeable at the Hohenlychen Sanatorium. Klein's activities there increasingly involved independent research or voluntary collaboration in the projects of other scientists that were closely connected to the SS and experiments on human beings in concentration camps. He never had to face justice. His role was not further investigated by the Allies - probably due to his non-existent Nazi party and SS membership.

The Editors of Scientific Journals in Dentistry in Nazi Germany and after 1945: A Sociodemographic Study.

This socio-demographic study examines the effects of the Nazification of the professional press in the Third Reich using the example of the dental press organs. Three subgroups were examined: (1) dental editors who lost their positions after Hitler assumed power; (2) editors who were newly appointed or confirmed in their positions during the Third Reich; and (3) editors who were recruited for these positions in the post-war period. The study was based on archival sources, contemporary registers, and dental journals from 1932-1949. These sources were supplemented by available secondary literature. A total of 34 editors were identified and their biographies reconstructed. Several of the editors appointed during the Nazi regime were able take up their positions again after 1945. Overall, the majority of editors appointed between 1945-1950 were former party members; in contrast, not a single Nazi victim was appointed to a position of this kind. We conclude in this article that denazification had no consequences for the specialist dental press. On the contrary, dentists who had benefited professionally from the Nazi regime during the Third Reich stood a good chance of furthering their careers after 1945.

Political pragmatist or man of conviction? Heinrich Bredt (1906-1989) and his involvement in the Third Reich.

Heinrich Bredt (1906-1989) has to be considered one of the most prominent German pathologists of the past century. While his scientific oeuvre - especially his research on pathology of the cardiovascular system - received widespread attention, his actual connection to National Socialism remains largely concealed. This paper takes this need for clarification as an occasion for a detailed investigation of Bredt's political role in the Third Reich, based on source material from Federal, State and University Archives. The analysis shows that Heinrich Bredt had already joined the anti-Semitic and anti-democratic Association of German Students in the 1920s, and from 1933 onward he entered various Nazi organizations - including the Nazi Party. Unlike in later statements, Bredt was not just a nominal member of the Party, he held various offices in National Socialist organizations and was accordingly classified as loyal to the regime by the Nazi authorities. In contrast, during his time in the socialist dictatorship of East Germany, Bredt remained aloof from the ruling Socialist Unity Party of Germany and its political organizations - unlike many former Nazi Party members who behaved in a political opportune manner in East Germany as well. Bredt demonstrated a distance from the socialist system which suggests that his political actions were guided not by pragmatic but by ideological considerations.

Nazi dentists before British courts: aspects on the role of the German dental profession in the Third Reich.

This study is the first to identify and investigate German dentists tried for war crimes by British courts after 1945. Drawing on wide-ranging archival court documents and sources from various international archives, we found and studied 11 dentists from the Third Reich who were put on trial, the majority of whom were accused of manslaughter, homicide or being accessories to murder. Of the accused, two were sentenced to death while the rest (n = 9) were forced to serve prison sentences. After their release, all nine of these dentists were able to resume and advance their professional careers in Germany, most as owners of a private dental practice (n = 8) and one as a clinic director. Many settled in small towns, where they became esteemed members of their local communities.