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Background: Ethics education rarely exists in pediatric resident curricula, although ethical conflicts are common in the clinical practice. Ethics education can prepare residents to successfully handle these conflicts. Aim: We searched for methods in teaching ethics to clinical and especially pediatric residents, and identified recurring barriers to ethics teaching and solutions to overcome them. Design: Literature from 4 electronic databases with peer-reviewed articles was screened in 3 phases and analyzed. The literature included papers referring to applied methods or recommendations to teaching ethics to clinical residents, and on a second level focusing especially on pediatrics. An analysis and critical appraisal was conducted. Results: 3 231 articles were identified. 96 papers were included. The applied learning theory, the reported teaching approaches, the barriers to teaching ethics and the provided solutions were studied and analyzed. Conclusions: We recommend case-based ethics education, including lectures, discussion, individual study; regular teaching sessions in groups, under supervision; affiliation to an ethics department, institutional and departmental support; ethics rounds and consultations not as core teaching activity; recurring problems to teaching ethics, primarily deriving from the complexity of residential duties to be addressed in advance; teaching ethics preferably in the first years of residency. We may be cautious generalizing the implementation of results on populations with different cultural backgrounds.

Policy responses to the economic crisis have manifest consequences to European population health and health systems. The aim of this article is to assess, by using the capability approach advanced by Sen, the ethical dimension of trade-offs made in health policy due to austerity measures. From a capability approach point of view, austerity measures such as reducing resources for health care, further deregulating the health care market or moving towards privatisation are ethically challenging since they limit opportunities and capabilities for individuals of a population. Public policies should thus aim to guarantee sufficient capabilities (options to access health care and possibilities to make healthy choices) for its populations. Prioritising those in need is a notion the capability approach particularly focuses on in its goal of supporting those with the least capabilities.

Public Health (PH) in Europe has become much more vocal about its moral understandings since 1992. The rising awareness that PH issues were inseparable from issues of human rights and social justice almost self-evidently directed the agenda of EUPHA and the European Public Health (EPH)-conferences. Problems of cultural and behavioural change, and environmental issues on a global scale were also added. The Section Ethics in PH invited the EPH community to join in 'arm chair thinking': coming together at conferences not only to share the 'how' and 'what' of PH research, practices and policies but also the 'why'. Time has been reserved to genuinely discuss what moral values are at stake in the work of PH and to actively develop a moral language and framework for PH Ethics. The challenge for the next decades is to find ways to involve the general public in the cultivation of a shared moral PH literacy.

The Covid-19 pandemic is not a war zone of combat and competing interests, but a ‘test of our humanity’, as the German president Frank-Walter Steinmeier said in his television speech on 11 April 2020. This is as time of carefully addressing ethical principles that both guide and challenge acts and policies, to investigate how these principles contribute to upholding humanity, and how they inform us about unsolvable dilemmas. These are times we have to act even though we might make the wrong decisions. Part of testing our humanity is preparing ourselves to face the wrong decisions that were made in times of uncertainty.

The changes initiated by the new National Civil and Commercial Code in Argentina underline the pediatric task to empower children's and adolescents' developing autonomy. In this paper, we have framed a model describing autonomy in child healthcare. We carried out a literature review focusing on i) the concept of autonomy referring to the absolute value of the autonomous individual, and ii) the age-driven process of competent decisionmaking development. We summarized our findings developing a conceptual model that includes the child, the pediatrician and the parents. The pediatricianchild relationship is based on different forms of guidance and cooperation, resulting in varying levels of activity and passivity. Parental authority influences the extent of autonomy, based on the level of respect of the child's moral equality. Contextual, existential, conceptual, and socialethical conditions shall be considered when applying the model to facilitate dialogue between pediatricians, children, parents and other actors.Los cambios del nuevo Código Civil y Comercial de la Argentina impulsa el desarrollo de la autonomía en niños y adolescentes. En este trabajo, estructuramos un modelo que describe la autonomía en la atención de la salud infantil. Hicimos un análisis bibliográfico enfocado en I) concepto de autonomía relacionado con el valor absoluto del individuo autónomo y II) el proceso de desarrollo de toma idónea de decisiones en función de la edad. Resumimos nuestros hallazgos mediante el desarrollo de un modelo conceptual en el niño, el pediatra y los padres. La relación pediatraniño se fundamenta en formas de orientación y cooperación con diversos niveles de actividad y pasividad. La autoridad de los padres influye sobre el grado de autonomía en función del nivel de respeto e igualdad moral del niño. Al aplicar el modelo para facilitar el diálogo entre pediatras, niños, padres y otros, se considerarán las circunstancias contextuales, existenciales, conceptuales y socio-éticas.

Childhood immunisation against seasonal influenza promises to reduce the burden of disease through herd immunity. The option of intranasal vaccination seemed to offer a more acceptable vaccination for children, as they are perceived to be less invasive. Yet, intranasal vaccines have been recently proven not to be as effective as presumed. In Germany, contradictory recommendations of the Standing Committee on Vaccination (STIKO) first, to use and then, in October 2016, not use these vaccines have been issued for the 2016-2017 season, whereas recommendations not to use them were already issued in the USA (CDC, ACIP). This controversy spurs the discussion of immunisation programmes for children again. Despite studies discussing the effectiveness of a comprehensive immunisation programme targeting children also in the German and wider European context, an accompanying ethical discussion is missing.We discuss several policy options from different key ethical perspectives that are widely used in public health: if seasonal influenza vaccination should be intensively offered to or even made mandatory for children to decrease the societal burden of the disease.Various ethical perspectives reflect the question how to balance individual autonomy, personal benefit and population benefit differently.A convincing justification for suggestions on immunisation policies has to balance norms anchored in different ethical theories. There are good reasons to offer immunisation programmes against seasonal influenza to children, using a voluntary, possibly incentive-based approach.Die Impfung von Kindern gegen saisonale Influenza um möglichst Herdimmunität zu erreichen, könnte die allgemeine Krankheitslast verringern und wird international diskutiert. Nasale Impfstoffe bieten eine neue Methode, die als sanfter empfunden werden könnte und somit potenziell akzeptabler für Kinder und Eltern erscheinen könnte. Allerdings haben sich diese Impfstoffe in jüngster Zeit als nicht so effektiv herausgestellt, wie erhofft. So gab es für die Grippe-Impfsaison 2016/2017 von der STIKO schon 2 verschiedene Empfehlungen, zuerst, die Impfung mit dem nasalen Impfstoff durchzuführen und, ab Oktober 2016, sie doch nicht fortzuführen. Die aktuellen Entwicklungen befördern Diskussionen von Kinder-Impfprogrammen. Obwohl einzelne Studien die Effektivität umfassender Impfprogramme gegen saisonale Influenza bei Kindern in Deutschland und Europa diskutieren, fehlt die ethische Betrachtung des Themas.Wir diskutieren aus ethischer Sicht mit Rückgriff auf zentrale und weithin im Bereich Public Health benutzte ethische Positionen, ob eine saisonale Influenzaimmunisierung im Kindesalter verstärkt angeboten werden oder sogar verpflichtend sein sollte, um die allgemeine Krankheitslast zu reduzieren.Bei der Anwendung diverser ethischer Perspektiven wird die Frage verschiedentlich beantwortet, wie man individuelle Autonomie, persönlichen und gesellschaftlichen Nutzen abwägen sollte.Eine überzeugende und plausible Rechtfertigung von Impfpolitiken muss verschiedene ethische Normen berücksichtigen und abwägen. Es gibt gute Gründe, Kindern gezielt Impfprogramme zur saisonalen Influenzaprävention anzubieten. Die Impfungen sollten allerdings freiwillig bleiben. Gleichwohl könnte man Anreiz-orientierte Ansätze erwägen.

A substantial body of evidence supports the beneficial health impact of an increase in primary care physicians for underserved populations. However, given that in many countries primary care physician shortages persist, what options are available to distribute physicians and how can these be seen from an ethical perspective? A literature review was performed on the topic of primary care physician distribution. An ethical discussion of conceivable options for decision makers that applied prominent theories of ethics was held. Examples of distributing primary care physicians were categorised into five levels depending upon levels of incentive or coercion. When analysing these options through theories of ethics, contrasting, and even controversial, moral issues were identified. However, the different morally salient criteria identified are of prima facie value for decision makers. The discussion provides clear criteria for decision makers to consider when addressing primary care physician shortages. Yet, decision makers will still need to assess specific situations by these criteria to ensure that any decisions they make are morally justifiable.

Patientenmobilitat und grenzuberschreitende Gesundheitsversorgung sind alltagliche Phanomene in der Europaischen Union (EU). Im Jahr 2011 hat die EU eine Richtlinie erlassen, um in diesem Kontext Rechtssicherheit herzustellen. Bisher gibt es keine umfassenden systematischen Studien uber ethische Aspekte grenzubergreifender Gesundheitsversorgung. In dieser Arbeit werden die rechtlichen Entwicklungen der grenzubergreifenden Gesundheitsversorgung dargestellt und die in der Literatur vereinzelt erwahnten ethisch relevanten Aspekte heuristisch und auf Patiententypologien aufbauend systematisch inventarisiert und diskutiert. Es zeigt sich, dass die Moglichkeit der Patientenmobilitat und die damit vor allem verbundenen Finanzierungsregelungen die Autonomie einiger Patienten sicherlich verbessern kann. Allerdings konnen wohl nicht alle Patienten Versorgungsverbesserungen erwarten. Im Gegenteil konnen sogar negative Konsequenzen fur einige Patienten folgen, was vor allem aus gerechtigkeitstheoretischen Uberlegungen kritisch zu sehen ist.

Personalized medicine (PM) is no longer an abstract healthcare approach. It has become a reality over the last years and is already successfully applied in the various medical fields. Although there are success stories of implementing PM, there are still many more opportunities to further implement and make full use of the potential of PM. We assessed the system readiness of healthcare systems in Europe to shift from the predominant ‘one size fits all’ healthcare approach to PM. We conclude that European healthcare systems are only partially ready for PM. Key challenges such as integration of big data, health literacy, reimbursement and regulatory issues need to be overcome in order to strengthen the implementation and uptake of PM.

Evidence emerging from the study of epigenetics and epigenomics challenges notions of health by enhancing understanding of disease etiologies and improving awareness of new health risks. New paradigms arising from epigenetic and epigenomic research present challenging cases through which to debate theories of justice in health because they expand the concept of health and, controversially, place value on what was previously assumed to be ‘healthy' individual variance. Discoveries of the dynamic nature of the epigenome and its variable sensitivity towards change in numerous phenomena add further complexity to the assessment of health inequalities. Such evidence can cast doubt on perceptions of justice in health, which in turn raises questions over the suitability of actions taken in pursuit of equity. This article discusses how recent developments in epigenetics and epigenomics may impact upon assessments of equity in health. A review of literature discussing possible health risks associated with acquired yet heritable epigenetic variance is used to highlight the diversity of possible pathways through which health may be influenced. From this context, the consideration of health risk with respect to epigenetics, it is argued, demands a more inclusive concept of health when used in discussions of inequities.

Aim: Nurses play a central role in disaster preparedness and management, as well as in emergency response, in many countries over the world. Care in a disaster environment is different from day-to-day nursing care and nurses have special needs during a disaster. However, disaster nursing education is seldom provided and a lack of curricula exists in many countries around the world. The aim of this literature review is to provide an overview of nurses’ roles, knowledge and experience in national disaster preparedness and emergency response. Methods: An electronic search was conducted using multiple literature databases. All items were included, regardless of the publication year. All abstracts were screened for relevance and a synthesis of evidence of relevant articles was undertaken. Relevant information was extracted, summarized and categorized. Out of 432 reviewed references, information of 68 articles was included in this review. Results: The sub-themes of the first main theme (a) roles of nurses during emergency response include the expectations of the hospital and the public, general and special roles of nurses, assignments of medical tasks, special role during a pandemic influenza, role conflicts during a disaster, willingness to respond to a disaster. For (b) disaster preparedness knowledge of nurses, the corresponding sub-themes include the definition of a disaster, core competencies and curriculum, undergraduate nursing education and continuing education programs, disaster drills, training and exercises, preparedness. The sub-themes for the last theme (c) disaster experiences of nurses include the work environment, nursing care, feelings, stressors, willingness to respond as well as lessons learned and impacts. Conclusion: There is consensus in the literature that nurses are key players in emergency response. However, no clear mandate for nurses exists concerning their tasks during a disaster. For a nurse, to be able to respond to a disaster, personal and professional preparedness, in terms of education and training, are central. The Framework of Disaster Nursing Competencies of the WHO and ICN, broken down into national core competencies, will serve as a sufficient complement to the knowledge and skills of nurses already acquired through basic nursing curricula. During and after a disaster, attention should be applied to the work environment, feelings and stressors of nurses, not only to raise the willingness to respond to a disaster. Where non-existent, national directives and concepts for disaster nursing should be developed and nurses should be aware of their duties. Nursing educators should prepare nurses for disasters, by adjusting the curricula and by meeting the increased need for education and training in disaster nursing for all groups of nurses. The appropriateness of theoretical and practical preparation of disaster nursing competencies in undergraduate nursing courses and continuing education programmes should be evaluated., South Eastern European Journal of Public Health (SEEJPH), Volume VII, 2017

Maastricht befindet sich innerhalb der Niederlande weitest möglich entfernt vom sogenannten Bibelgürtel. Einerseits geographisch, denn Maastricht liegt im äußersten südlichen Zipfel der Niederlande, während der Gürtel das Land in der Mitte abschnürt. Aber auch ideologisch ist die Entfernung groß, denn während der Bibelgürtel aus reformierten, orthodox-protestantischen Strömungen besteht, ist Maastricht sehr katholisch. Die – gefühlt – halbe Universität ist untergebracht in alten Klöstern. Hörsäle befinden sich in vormaligen Kapellen. Natürlich ist Maastricht mittlerweile eine weltanschaulich offene Stadt. Die Universität ist mit ihren Studierenden und Mitarbeiterinnen und Mitarbeitern ein weltoffener, internationalisierter Schmelztiegel.

The results of the study Benchmarking Regional Health Management II suggest that compulsory measles immunisation is a good practice in public health management. Yet, the potential achievement of the desired health outcome alone is not a sufficient reason to make the immunisation obligatory. Rather, compulsory measles immunisation is a morally challenging measure. In this article, compulsory measles immunisation is critically evaluated from a public health ethics point of view. For this evaluation, a set of ethical criteria is proposed: respect for autonomy, health maximisation, efficiency, proportionality and social justice. The authors suggest it should not be taken for granted that compulsory measles immunisation should be championed, rather, health policy makers in the European Union should try to raise immunisation rates with non-compulsory means.

Die Integration genombasierten Wissens in Forschung, Politik und Praxis von Public Health wird eine der grosten Herausforderungen fur unsere Gesundheitssysteme darstellen. In diesem Kontext tragt Public Health Genomics (PHG) als verantwortungsvolle und effektive Umsetzung genombasierten Wissens und genombasierter Technologien in die Gesundheitspolitik und Gesundheitsversorgung entscheidend zur Verbesserung der Gesundheit der Gesamtbevolkerung bei. Die verschiedenen Public-Health-Akteure sind gefordert, diese Innovationen, die aus Bereichen wie Systembiologie, Epigenomik, Integrativer Genomik, Umwelt-Genomik-Interaktionen resultieren, zeitnah in personalisierte und zielgruppenorientierte Interventionen zu integrieren. Insbesondere die aktuellen Ergebnisse aus der Systembiologie stellen bereits heute klassische Krankheitsklassifikationen wie etwa die ICD10, populationsbezogene genetische Screenings oder auch epidemiologische Modelle wie traditionelles HTA infrage. Das Public Health Genomics European Network (PHGEN) erfullt diese Aufgabe der Translationsforschung in Europa.

In the aftermath of the economic crisis that started in 2008, resources have become scarcer than ever in some countries, also in health care. Priority setting and rationalisation of existing resources also affect pharmaceutical innovations, including those that would contribute to what is called personalised medicine. In this paper, we will highlight the ethical issues surrounding rationalisation and its impact on personalised medicine through the lens of the capability approach. Thereby, challenges to and opportunities for personalised medicine will be examined, assessing how they affect patients' ‘real options' to access innovative therapies. In our focus on the ‘first challenge: citizens and patients' of the so-called Strategic Research and Innovation Agenda, the strength of the capability approach becomes particularly apparent in identifying what different values are at stake in this context.

Aim: Risk factors for child injury are multi-faceted. Social, environmental and economic factors place responsibility for prevention upon many stakeholders across traditional sectors such as health, justice, environment and education. Multi-sectoral collaboration for injury prevention is thus essential. In addition, co-benefits due to injury prevention initiatives exist. However, multi-sectoral collaboration is often difficult to establish and maintain. We present an applied approach for practitioners and policy makers at the local level to use to explore and address the multi-sectoral nature of child injury. Methods: We combined elements of the Haddon Matrix and the Lens and Telescope model, to develop a new approach for practitioners and policy makers at the local level. Results: The approach offers the opportunity for diverse sectors at the local level to work together to identify their role in child injury prevention. Based on ecological injury prevention and life-course epidemiology it encourages multi-disciplinary team building from the outset. The process has three phases: first, visualising the multi-sectoral responsibilities for child injury prevention in the local area; second, demonstrating the need for multi-sectoral collaboration and helping plan prevention activities together; and third, visualising potential co-benefits to other sectors and age groups that may arise from child injury prevention initiatives. Conclusion: The approach and process encourages inter-sectoral collaboration for child injury prevention at the local level. It is a useful addition for child injury prevention at the local level, however testing the practicality of the approach in a real-world setting, and refinement of the process would improve it further., South Eastern European Journal of Public Health (SEEJPH), Volume I, 2014

Einleitung Ethischen Aspekten wird in der Epidemiologie angesichts der zahlreichen ethischen Herausforderungen des Forschers gegenüber Probanden und Gesellschaft immer mehr Beachtung geschenkt. Mit Wissen über ethische Normen (z.B. Autonomierespekt, Gerechtigkeit, Gesundheitsmaximierung) und Methoden können Konflikte in der Forschung besser erkannt und erörtert werden. Deswegen sollte Ethik auch fester Bestandteil epidemiologischer Ausbildung sein.

Despite sound scientific knowledge and evidence that any exposure to asbestos fibers in all of its forms, are carcinogenic to humans, its presence, use and trade is still substantial, including in the World Health Organization (WHO) European Region. Banning the production and use of all forms of asbestos, as recommended by the International Labour Organization (ILO) and WHO, has been proven as the most efficient evidence-based strategy to eliminate Asbestos Related Diseases (ARDs). To effectively move elimination of ARDs forward, attaining a greater understanding of key stakeholders perspectives was identified as an important action. The WHO Regional Office for Europe, the European Centre for Environment and Health, undertook semi-structured interviews, and follow-up discussions with diverse representatives dealing professionally with asbestos. The interview questionnaire was developed based on the current ARDs WHO Report, the Evidence Implementation Model for Public Health and categories of the theory of diffusion. Data were attained on three main questions within the interview questionnaire: (1) Identifying barriers to implementation of WHO evidence-based asbestos recommendations; (2) Describing roles of key stakeholders; and, (3) Proposing possible solutions. The results demonstrated use of sound and convincing scientific evidence along with economic evidence and facilitators can be used to achieve evidence-based policy development, and comprehensive diverse actions.

South Eastern European Journal of Public Health (SEEJPH), Volume II, 2014

BackgroundProfessional development of public health leaders requires a form of instruction which is competency-based to help them develop the abilities to address complex and evolving demands of health care systems. Concurrently, emotional intelligence (EI) is a key to organisational success. Our aim was twofold: i) to assess the relationship between the level of self-assessed public health and EI competencies among Master of European Public Health (MEPH) students and graduates at Maastricht University, and; ii) to determine the relationship between different groups of public health competencies and specific EI skills. MethodsA cross-sectional study was conducted including all recent MEPH graduates and students from 2009-2012, out of 67 eligible candidates N = 51 were contacted and N = 33 responded (11 males and 22 females; overall response: 64.7%).Two validated tools were employed: i) public health competencies self-assessment questionnaire, and; ii) Assessing Emotions Scale. ResultsFemales scored higher than males in all seven domains of the self-assessed key public health competencies (NS) and emotional intelligence competences (P = 0.022). Overall, the mean value of public health competencies was the lowest in students with "staff" preferences and the highest among students with mixed job preferences (P ConclusionsThe study shows a positive correlation between public health specific competencies and EI attributes. It can contribute to the improvement of the educational content of PH curricula by rising awareness through self-assessment and supporting the identification of further educational needs related to leadership.

The European White Paper "Together for Health" states that reducing health inequalities is an important goal for European health strategies. At first sight, all European countries have universal insurance coverage, implying that there is universal and equal access to health care services. Several studies have shown, however, that this is not the case. Also, although there has been some research on the subject, information on differential health care utilization is incomplete. By taking a look at Andersen’s conceptual framework on the access of health care services and literature on the subject, we composed a list of individual demographic and socioeconomic determinants of health care utilization that should be available in several databases if one’s aim is researching the subject. The aim of this paper is to evaluate whether European data sources make analyses on individual demographic and socioeconomic determinants of health care service utilization possible with the data that is provided. The Health for All Database does not seem to focus on utilization measures and the necessary demographic and socioeconomic indicators, making ecological correlational studies difficult. Eurostat provides more opportunities for this. The European Social Survey does allow some analysis on the subject. However, health care utilization measures are rather limited. The European Health Information Survey includes all of the necessary determinants, as well as measures of health care utilization. Comparability of data resulting from this survey might, however, be restricted.

Issue/problem Effective advocacy for change in healthy policies and interventions requires knowledge of which actors are involved in the adoption, implementation and monitoring phase. This is often not transparent, particularly in the area of child safety where multiple sectors are often involved. Advocacy efforts could be facilitated by a tool that provides a way to explore and describe existing relationships between actors involved in a given intervention. The mapping of responsibilities …

The current protracted economic crisis is giving rise to the scarcity of public health resources across Europe. In response to budgetary pressures and the Eurozone public debt crisis, decision-makers resort to a short-term solution: the introduction of austerity measures in diverse policy fields. Health and social policy tend to be easy targets in this regard and budget cuts often include a reduction of healthcare expenditure or social welfare benefits. We suggest incorporating discussions from the field of ethics in policy making processes and in the academic debate on austerity. This includes recognising procedural justice as a social value. On the road to economic recovery, governments are compelled to resort to fiscal consolidation and austerity packages but decisions taken to save our European ships in crisis should be anchored in values such as (procedural) justice, equity and solidarity. Open access journal

SUMMARY Background: In 2007 the European Commission issued the White Paper: “Together for Health”. Considered the EU Health Strategy for the years 2008−2013, it offers the cornerstones for setting priorities in EU health actions. Objectives: The public health framework offered in this strategy is explicitly built on shared values – including the overarching values of universality, access to good quality care, equity and solidarity that reacted to certain health care challenges within the EU. This article analyses the Health Strategy via its ethical scope and considers implications for future health policy making. Methods: The Health Strategy and related documents are scrutinised to explore how the mentioned values are defined and enfolded. Addition ally, scientific databases are searched for critical discussions of the value base of the Health Strategy. The results are discussed and reasoned from a public health ethical perspective. Results: The Health Strategy is barely documented and discussed in the scientific literature. Furthermore, no attention was given to the value base of the Health Strategy. Our analysis shows that the mentioned values are particularly focussed on health care in general rather than on public health in particular. Besides this, the given values of the Health Strategy are redundant. Conclusions: An additional consideration of consequentialist public health ethics values would normatively strengthen a population-based health approach of EU health policy making.

Public health ethics is gaining recognition as a vital topic for public health education. The subject was highlighted in a Delphi survey of future priorities of member schools of The Association of Schools of Public Health in the European Region (ASPHER). We conducted a survey of teaching public health ethics in Bachelors and Masters of Public Health programmes targeting all 82 ASPHER member schools in 2010/2011, as an initiative toward improving ethics education in European Schools of Public Health. An eight-items questionnaire collected information on teaching of ethics in public health. A 52 percent response rate (43/82) revealed that nearly all of the responding schools (40 or 95% of the respondents with valid data) included the teaching of ethics in at least one of its programmes. They also expressed the need for support, (e.g., a model curriculum (n=25), case studies (n=24)), which indicates an area for further work to be met by the ASPHER Working Group on Ethics and Values in Public Health. This survey will help guide development of this topic as a teaching priority in public health education in Europe.

In 2005, WHO Europe reconfirmed the objective of eradicating measles and fixed a strategy plan for the years 2005 up to 2010. While a downward trend of measles infections in Germany between 2001 and 2004 could be observed, as many as 780 cases of measles were reported in 2005 and in 2006 even 2.281 cases. These high figures in 2006 were almost exclusively caused by an outbreak in the German region of North Rhine-Westphalia. This case study describes how a reference framework for good health management of measles prevention was applied for this region. As a result, various recommendations for action could be given, among them the recommendation to implement individual vaccination reminder systems for parents and bonus systems for parents. Based on these results, a comprehensive policy concept has been drawn up and has become the subject of a political agreement process in this region. Thus this case study shows a paradigm how reference frameworks for good health management can be utilised in practice.

Public health genomics (PHG) relies on developing knowledge from a variety of natural and social science research disciplines to shape public policies, health policy, education and training, and direct outreach to organisations and the population at large. All of these components rely on the involvement of stakeholders who, because of the diverse groups involved, will have a wide range of backgrounds. The significant challenges associated with the engagement of such a diverse range of stakeholders are compounded by the wide knowledge gaps that exist between scientists, the public, and different professional groups. In this paper we discuss some of the areas of public policy that might involve PHG, set out principles on the need for stakeholder involvement, and describe the range of potential stakeholders that need to be considered when working to incorporate PHG into new and existing policies. For specific projects in PHG, however, the question of who to involve and how must be addressed according to the work in question.

In this article, the authors attempt to build a bridge between economic theory and medical ethics to offer a new perspective to tackle ethical challenges in the physician-patient encounter. They apply elements of new institutional economics to the ethically relevant dimensions of the physician-patient relationship in a descriptive heuristic sense. The principal-agent theory can be used to analytically grasp existing action problems in the physician-patient relationship and as a basis for shaping recommendations at the institutional level. Furthermore, the patients' increased self-determination and modern opportunities for the medical laity to inform themselves lead to a less asymmetrical distribution of information between physician and patient and therefore require new interaction models. Based on the analysis presented here, the authors recommend that, apart from the physician's necessary individual ethics, greater consideration should be given to approaches of institutional ethics and hence to incentive systems within medical ethics.