Possible age-related differences in healthcare professionals' perspectives on younger and older patients' autonomy and decision-making in the context of sedation in specialised palliative care: exploratory secondary qualitative content and linguistic conversation analysis of interviews with healthcare professionals.

BACKGROUND: Chronic illnesses and multi-morbidity can threaten competence and independence, particularly in old age. Autonomy becomes increasingly important in the context of sedation, as in this case medication leads to (further) changes of consciousness. The study aimed to identify possible age-related differences in the perspectives of healthcare professionals on patients' autonomy, in the context of sedation in specialised palliative care. METHOD: Secondary analysis of interviews with healthcare professionals, analysed by qualitative content and linguistic conversation analysis. The interviews analysed span 51 healthcare professionals in specialised palliative care across 17 centres (adult inpatient and specialist palliative home care services) in Germany. RESULTS: The study shows that the perspectives of healthcare professionals on patients' autonomy differs according to the age of the patient in the context of sedation in specialised palliative care. The different perspectives may lead to different ways of treating the patients, for example a greater space of autonomy and decision-making for younger patients. CONCLUSION: In particular, measures that may restrict consciousness (e.g. sedation) and thus influence patients' ability to fully exercise their autonomy and fully participate in decision-making require special attention by healthcare professionals with respect to possible influences on treatment, such as different perceptions by healthcare professionals based on the patient's age or age-related stereotypes. TRIAL REGISTRATION: The study "SedPall" is registered in the German Clinical Trials Register (ID: DRKS00015047 ).

Young for old-old for young? Ethical perspectives on intergenerational solidarity and responsibility in public discourses on COVID-19.

In the wake of the Coronavirus pandemic, intergenerational solidarity and responsibility have become central points of reference in public discourses. However, the use of these concepts is often unclear and ambivalent: On one hand, older people are described as a vulnerable group whose protection requires sacrifices on the part of younger generations, e.g., regarding individual freedom and economic welfare. On the other, they appear as dispensable individuals that should relinquish their claims for the sake of the young and their future prospects. Our contribution offers an analysis of intergenerational solidarity and responsibility in public discourses on COVID-19. The leading question is how both concepts are used and how the corresponding claims can be justified or criticized. We first give an overview of notions of intergenerational solidarity and responsibility in current debates. In the next step, we provide a moral philosophical clarification of both concepts and their normative presuppositions. We then conduct a descriptive ethical discourse analysis of pertinent cases from three areas of European discourse: politics, civil society, and mass media. The analysis focuses on politico-moral claims and their normative premises, ambiguities, and biases. We argue that the discourse involves assumptions about old age and generational relations that need further clarification and justification. An analysis of intergenerational solidarity and responsibility in times of COVID-19 can help understand the dynamics of social cohesion in late-modern societies.

Critical analysis of communication strategies in public health promotion: An empirical-ethical study on organ donation in Germany.

Given the need for organs, public organizations use social marketing strategies to increase the number of donors. Their campaigns employ a variety of moral appeals. However, their effects on audiences are unclear. We identified 14 campaigns in Germany from over the last 20 years. Our approach combined a multimodal analysis of categorized posters with a qualitative analysis of responses, collected in interviews or focus groups, of 53 persons who were either skeptical or undecided about organ donation. The combined analyses revealed that the posters failed to motivate laypersons in general to donate, and were even less effective on skeptical or undecided individuals. We explain this in terms of the types of moral messages found on posters and the limits of such social marketing strategies. Furthermore, we discuss certain ethical aspects of organ donation campaigns pertaining to communicating norms and trust in public institutions.

'Saying no to organ donation': an empirical typology of reluctance and rejection.

In Germany, as well as in other countries, organ shortages are usually explained by a relative unwillingness to donate among a population which is assumed to be caused by a lack of information and mistrust of the system. As we can see in the data of our qualitative research (focus groups and interviews), lack of information or mistrust are not the only reasons for people to be reluctant to agree to the donation of their organs after death. In fact we can identify four positions: (1) information deficit; (2) mistrust; (3) no killing; and (4) bodily integrity. The first and second are the two prominent explanations in the public discourse about low donation rates. The third and the fourth instead have neither been adequately articulated nor been discussed as a proper argument. Therefore, by means of sociology of critique, we discuss their contribution to the discourse as comprehensible reasons for reluctance and present them as credible positions of criticism: These two positions illuminate fundamental and universal values of the inviolability of the person and human dignity. Thus, both positions are consistent and morally justifiable and should be addressed with sensitivity.

"Are You In or Are You Out?!" Moral Appeals to the Public in Organ Donation Poster Campaigns: A Multimodal and Ethical Analysis.

Organ transplantation is a well-established practice in modern medicine. However, many countries, especially those with an opt-in regulation, face the problem of low donation numbers. Respective public campaigns attempt to increase the number of donors by swaying public opinion with the use of carefully selected bits of information. Germany serves as a case study for an opt-in country investing approximately €7.5 million/year in the distribution of respective campaigns. To address diverse populations, large-scale posters in various public spaces still display a multitude of moral messages for organ donation. We developed a detailed multimodal approach for the analysis of health communication by focusing exemplarily on such organ donation poster campaigns as a common mean since the 1990s. In all, we identified 13 campaigns with 83 posters from 1996 to 2016. Here, we focus on both the textual and visual elements of such material to analyze how morally relevant principles and virtues are interwoven. Six categories of moral appeals were identified in the complete sample: altruism, being a decisive person, family responsibility, minimizing suffering, social conformity, and complete reciprocity. Overall, visual items were used to create a variety of social, moral, and epistemic claims with respect to organ donation. Our analysis reveals critical aspects highlighting the potential conflicts that arise from the ambiguity and wrong information of some messages as well as the risk of inappropriate blaming driven by these campaigns.

Colonization of later life? Laypersons' and users' agency regarding anti-aging medicine in Germany.

Anti-aging medicine is regarded as a significant trend in contemporary Western societies. Foucauldian gerontology provides some of the dominant theoretical perspectives on this trend in social and cultural theory. Proceeding from its interpretation and critique of anti-aging in terms of medicalization and responsibilization of aging, we explore by means of qualitative socio-empirical research how interested laypersons as well as non-professional users in the German context actually perceive of and deal with the medical claims and moral imperatives surrounding anti-aging medicine. The study is based on 12 focus groups and 20 narrative interviews (96 participants all included). They were conducted in Germany between 2011 and 2012, and analyzed by qualitative content analysis as well as comparative sequence analysis. The empirical findings indicate that in everyday life, interested laypersons and non-professional users employ different strategies for dealing with anti-aging products and services, corresponding to different degrees of affirmation and rejection. Four strategies could be identified: (a) medical optimism, (b) preventive maximalism, (c) ritualized well-being, and (d) considerate rejection. Also, each type was problematized and arguments against it were expressed. Overall, these findings show how our participants develop viable strategies to put the relevance of medical knowledge and moral imperatives for their own lives into perspective. This sheds light on laypersons' and users' agency-that is, their active role and deliberative space in the uptake, adaptation, and integration of anti-aging into their personal life. These empirical findings contribute to an enriched picture of the actual practice of anti-aging in concrete national and socio-cultural settings. This can help to differentiate the evaluation and thus make its critique more context sensitive, adequate, and targeted.