Contact

 

Prof.Dr.med.Dr.phil. Eva Winkler

Please contact:
Dr. phil. Christoph Schickhardt
Phone: +49 6221 5636756

E-mail: eva.winkler@med.uni-heidelberg.de

 

 

Ethics supports...

 

sound decision making in medical treatment and research.

Ethics and Patient oriented Care in Oncology (NCT-EPOC)

 

Due to the impressing medical and technical progress and structural changes in health care, ethical issues in oncology and research constantly gain importance. Such issues include the informed consent process in research, the patient’s rights and the right to self-determination or the ethical justification of expensive treatments when resources are limited in health care. The concept of Empirical Ethics is combines empirical studies in patient care and research with ethical analysis (cf. figure 1).

The empirical research allows for a detailed account of the ethical questions at stake. The ethical analysis weighs the values and ethical principles affected and develops an ethically sound recommendation. This recommendation aims at informing our decisions in the clinical or research context - be it as an aid in decision-making, as an advice or a counselling service

Model of empirical ethics that starts with the clinical or research question that causes moral distress, specifies the ethical question based on empirical research and leads to an ethical analysis and recommendation that is finally brought back to  those who need to make value laden decisions in the clinical or research setting

NCT-EPOC research, teaching and clinical activities focus on the following 3 fields:

Clinical Ethics

I. End-of-Life Decision Making
EPAL: Leitlinie zur Therapiebegrenzung der Medizinischen Klinik und Poliklinik III des Klinikums der Universität München»

II. Ethical issues of the use of electronic health records 

Ethics and Genomics

III. Research Ethics and ethical requirements for the informed consent process in Next Generation Sequencing 

IV. DASYMED: Big Data in Systems Medicine. Normative and Social Aspects for Physicians, Scientists, Patients and Society»

Ethics and Health Policy

V. Prioritization and Ressource allocation in Oncology

Goal: Facilitating fair and effective allocation of resources in Oncology

Practical Acchievements:

  • EURAT Position Paper (Cornerstones for an ethically and legally informed practice of Whole Genome Sequencing: Code of Conduct and patient consent models)
  • Ethical framework for evaluating a patient's request for life-prolonging treatment
  • Guideline on changing and communicating the goal of care (curative to palliative)
  • Ongoing Interdisciplinary seminar series about ethical conflicts in decision- making (in Collaboration with the Department of Hematology/Oncology, Radiation Therapy, Theology, Psychology)
  • Establishment of a working group “Medicine and Ethics” at the German Society for Hematology and Oncology

Publications:

  • Winkler EC, Ose D, Glimm H, Tanner K, von Kalle C.” Personalized Medicine and Informed Consent: Clinical and ethical considerations fora best practice guideline for biobank based Whole Genome Research in Oncology. Ethik in der Medizin 2013, Vol 25, 169-172
  • Krause SW, Schildmann J; Lotze Ch; Winkler EC, "Rationing Cancer Care: A Survey Among the Members of the German Society of Hematology and Oncology" J NatlComprCancNetw 2013;11:658-665
  • Winkler EC, Hiddmann W, Marckmann G „ Evaluating a patient’s request for life-prolonging treatment: An ethical decision aid“ Lancet Oncology August 2011, Vol 11, 720-22.
  • Hauke D, Reiter-Theil S, Hoster E., Hiddemann W., Winkler, EC  “The role of relatives in decisions concerning life-prolonging treatment in patients with endstage malignant disorders: Informants, advocates or surrogate decision-makers. Ann Oncol. 2011 Dec;22(12):2667-74
  • Winkler EC, Reiter-Theil S, Lange-Rieß D, Schmal-Menges N, Hiddemann W; Patient involvement in decisions to limit treatment: the crucial role of agreement between physician and patient. J ClinOncol 2009 (27) :2225-2230

Funding:

  • German CancerAid - Deutsche Krebshilfe e.V.
  • German Ministryfor Education and Research (Bundesministerium für Bildung und Forschung)
  • Early Clinical development Research (DKFZ)
  • Marsilius-Kolleg (Initiative of Excellence)

EURAT: Ethical and Legal Aspects of Whole Genome Sequencing»

The interdisciplinary EURAT project group is sponsored by the Marsilius Kolleg (Initiative of Excellence) of Heidelberg University. It is engaged in normative issues that arise in Whole Genome Sequencing in the fields of research and patient care and has published on this subject among other things the EURAT Position Paper “Eckpunkte für eine Heidelberger Praxis der Ganzgenomsequenzierung“ [Cornerstones for the Heidelberg practice of whole-genome sequencing].


DASYMED: Big Data in Systems Medicine – Normative and Social Issues for Physicians, Scientists, Patients and Society»


DASYMED is a research project funded by the Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung). It is carried out in collaboration with the The Institute for German, European and International Medical Law, Public Health Law and Bioethics (IMGB) (Mannheim) and is divided into an ethical, a socio-empirical and a legal subproject. The research covers normative implications and issues arising due to new practices in systems medicine in the field of biomedical research and patient care.


Ethics policy for advanced care planning and limiting treatment (EPAL-Study)
(Leitliniengestützte Interventionsstudie zur Verbesserung von Entscheidungen zur Therapiebegrenzung)
Leitlinie zur Therapiebegrenzung der Medizinischen Klinik und Poliklinik III des Klinikums der Universität München»

End-of-life decision-making in cancer patients is often surrounded by clinical, ethical and psychological conflicts and can therefore be a challenging process for patients, relatives and the medical team. The aim of the EPAL study (Ethics policy for advanced care planning and limiting treatment) is the development and implementation of a clinical practice guideline about limiting life-prolonging treatment as well as the evaluation of its impact on medical practice in the Dept of Internal Medicine, which runs a comprehensive cancer center at the Munich University Hospital, with respect to the following criteria:

  1. knowledge and consideration of the patient's wishes,
  2. reduction of conflicts in decision-making,
  3. better transparency through standardized documentation and
  4. reduction of the burden on the health care team.

In order to identify changes in these variables we use a pre-post study design before and after implementation of the policy. The epistemological aim is to contribute to the discussion of methods and to the evaluation of ethical guidelines. Although guidelines are common in medical practice, the influence of ethics policies on clinical decision-making is so far unclear.

The study is funded by Deutsche Krebshilfe e.V.


INFOPAT: Medical ethics implications regarding the doctor-patient relationship under the influence of a personal  electronic patient record


In May 2015 the German cabinet approved a legislative bill concerning secure digital communication and applications in health care, the so called ‘e-health act’. By means of this act a basis for health IT-applications – like for instance electronic health records – should be established. The INFOPAT project aims at linking all relevant player in the healthcare system via a personal electronic patient record (PEPA). The project „Gesundheitsregion der Zukunft“ (INFOPAT Rhein Neckar) is funded by the Federal Ministry of Education and Research (BMBF) and an alliance of 27 partners under the lead of the Dept of Health Service Research, University of Heidelberg. An essential idea of this project is that every patient is made administrator of a data-cloud, containing all his medical data. This shall not only improve consistency of care, but also realize the right to informational self-determination. However, these new options to put the patient at the center of information management in a comprehensive and self-determining way provide essential new ethical challenges to the relationship between physicians and patients. Our project focuses on the empirical needs analysis, development and ethical evaluation of the implementation of the PEPA prototype.

Team

Prof. Dr. med. Dr. phil. Eva Winkler
Head of the program EPOC,
Project Speaker EURAT
Email: eva.winkler@med.uni-heidelberg.de

Simone Dippel
DASYMED
Email: simone.dippel@med.uni-heidelberg.de

 

Dipl.-Soz. Sandra Fernau
DASYMED
Tel.: +49 6221 56-35022
Email: sandra.fernau@med.uni-heidelberg.de

Dr. phil. Katja Mehlis
EPAL-Study, INFOPAT
Tel.: +49 6221 56-35727
Email: katja.mehlis@med.uni-heidelberg.de

 
 

Dr. phil. Christoph Schickhardt
DASYMED
Tel.: +49 6221 56-36756
Email: christoph.schickhardt@med.uni-heidelberg.de

Sebastian Schleidgen, M.A.
DASYMED
Tel.: +49 6221 56-35208
Email: sebastian.schleidgen@med.uni-heidelberg.de

 

Sebastian Schuol, M.A.
EURAT
Tel.: +49 6221 56-34609
Email: sebastian.schuol@med.uni-heidelberg.de

 
 

Dr. med. Mareike Dietrich
Medical Oncology
Tel.: +49 6221 56-35917
Email: mareike.dietrich@med.uni-heidelberg.de

Dr. med. Helene Hofmann
Medical Oncology
Tel.: +49 6221 56-37216
Email: helene.hofmann@med.uni-heidelberg.de

 

Dr. rer. med. Katsiaryna Laryionava
EPAL-Study
Email: katsiaryna.laryionava@med.uni-heidelberg.de

 
 

Pia Schwab
DASYMED

Dr. med. Stefanie Zschäbitz
Medical Oncology
Email: Stefanie.zschaebitz@med.uni-heidelberg.de