![[Translate to English:]](/fileadmin/_processed_/9/b/csm_Firefly_Abstract_organic_flow_resembling_blood_vessels_shaped_as_a_tool__composed_of_glowing_651800_26778ea790.png "[Translate to English:]")
The Clinical Ethics group at the IMDE examines the ethical dimensions of medical decision-making processes in modern cancer care and related clinical contexts. Our research focuses on issues surrounding the complexity of treatment decisions in advanced-stage disease, medically assisted dying, and the ethical challenges in the care of older and vulnerable patients. This includes investigating the moral burden experienced by healthcare professionals in difficult end-of-life situations, as well as developing guidelines and preference-based tools to support shared decision-making. Furthermore, we analyse the perspectives of various stakeholders in data-driven medical settings and investigate how economic factors shape clinical decision-making situations. In our work, we place particular emphasis on taking into account the perspectives of all those involved – patients, relatives, the medical team, and experts in the relevant fields and in ethics.
Projects
Children and Youth in Medicine
Best Interests of the Child, Quality Care, Counseling, Pediatric and Adolescent Oncology
What are the criteria for quality care for children and adolescents? Given the highly development-specific characteristics of children and adolescents, this question is even more complex than it is for adults. We are therefore discussing it together with pediatric oncologists from the Society for Pediatric Oncology and Hematology (GPOH).
From an ethical perspective, we focus on a child-centered interpretation of the best interests standard and the best interests of the child. Key considerations here include the balancing of the child’s and the family’s interests (child-centered vs. family-centered care), the definition of the child’s interests, and which of the child’s interests should be taken into account in medical decisions (a purely medical or a holistic approach). This approach is supplemented, on the one hand, by the rights of the child as set forth in the UN Convention on the Rights of the Child and the rights of the child in the hospital as outlined in the Charter of the European Association for Children in Hospital (EACH Charter), which also incorporate the concepts of the child’s well-being and the best interests of the child.
Ultimately, this also involves considering questions such as: Who determines what is in the child’s best interests? How do the child’s various interests relate to one another (and to the interests of other stakeholders, such as other patients and family members)?
Children’s and young people’s rights to participation
With regard to children’s rights to participation, questions arise such as: What degree of autonomy and decision-making capacity can be attributed to children or young people? How might shared decision-making look in the case of children and young people of different ages?
Publications
Schickhardt C.: Children as vulnerable patients in oncological medicine and treatment, In: Ethics and Oncology: New Issues of Therapy, Care, and Research, hrsg. von M. Bobbert, B. Herrmann und W. U. Eckart, Karl Alber, 67-80, 2017.
Schickhardt, C.: The Significance and Value of Consent, with Particular Reference to Tissue Donation between Siblings, in: Siblings as Saviours: Ethical Aspects of Consent in Paediatric Stem Cell Transplantation, edited by C. Schües and C. Rehmann-Sutter, Mentis Verlag, 101–121, 2015.
presentations (selection)
25 June 2026 What constitutes good treatment in paediatric and adolescent medicine? A comprehensive perspective from the field of paediatric ethics, Schickhardt C., Sulzbach N., Workshop on the Well-being of Children, Adolescents and Adults with Rare Diseases, Institute for Ethics and History of Medicine / Department of Neuropaediatrics and Muscular Disorders, University Medical Centre Freiburg, online.
17 April 2026 What constitutes good treatment in paediatric oncology? A comprehensive perspective on paediatric ethics, Sulzbach N., Schickhardt C., Academy for Ethics in Medicine (AEM) Spring Conference, online.
19 September 2025 Short presentation and panel discussion on the topic ‘Sick children have rights. How are the rights of sick children implemented?’ Frankfurt am Main, organised by Hilfe für krebskranke Kinder Frankfurt e. V. and Kinderhilfestiftung e.V.
19 February 2021 Decision-making in complex medical situations; Compassionate Care, Prenatal Diagnostics, moral and ethical issues and decisions. Online BVHK Advisory Board Meeting, Federal Association for Children with Heart Disease e.V.
2 June 2016 A child ethics perspective on the tension between the child’s best interests, the child’s wishes and the parents’ wishes, Congress on the Child’s Best Interests in Hospital, University Children’s Hospital Zurich.
IMDE Contact Partners
IMPULS-A (Implementation of a Support Program for Older Long-Term Cancer Survivors)
More and more older adults are surviving cancer, but they often have long-term physical, psychological, and social support needs. The IMPULS-A project develops, implements, and evaluates a regional survivorship program for cancer survivors aged 70 and older. The program focuses on regular needs assessments, the coordination of individualized support services by care navigators, and the integration of existing care structures. The program’s effectiveness is being examined in a randomized controlled trial. The goal is to sustainably improve the quality of life, health literacy, and social participation of older cancer survivors and to develop a transferable model for needs-based follow-up care. As an additional qualitative research question, the study examines which aspects are important to older adults in terms of a fulfilling life after cancer.
Publications
Bugaj T. J., Flock C., Scapinello E., et al. Evaluating an innovative support programme for older long-term cancer survivors (IMPULS-A): protocol for a randomised controlled trial. BMJ Open 2026;16:e119397. doi: 10.1136/bmjopen-2026-119397
IMDE Contact Partners
Completed Projects
ELABORATE (The Influence of Economic Factors on Medical Decision-Making: Ethical Responsibility in Modern Oncology)
Possible economic influences on medical practice are summarised under the term "economisation" and are subject of current professional, social and political discussions. Nevertheless, the assessment and meaning of the term "economisation" remains unclear. A fuzzy concept of economisation complicates both the exchange about the subject matter and the normative evaluation of practices. Especially oncology as a cost-intensive subarea of medical practice, lacks interdisciplinary conceptual and ethical studies on the characterisation and normative evaluation of economic factors influencing oncological practice.
Within the framework of the interdisciplinary collaborative research project, in which medical ethics, oncology and health economics work closely together it is planned to characterise and define the term and concept of "economisation", evaluate and describe economic factors influencing oncological practice with qualitative analysis, confirm the results in a quantitative analysis of insurance data and together with relevant stakeholders develop recommendations on how to deal with negative economic influences in oncological practice.
With combined expertise from oncology, medical ethics, and health economics this project pursues the following objectives:
Aims of the project
- Identify relevant/ typical decision-making situations in inpatient and outpatient oncology practice and characterise the economic influence on those decision-making situations.
- Examine selected decision-making situations and possible influencing economic factors by a quantitative analysis of the billing data of a large statutory health insurance company.
- Identify and justify possible measures to appropriately manage influencing economic factors.
- Stakeholder evaluation of the results and derived recommendations with regard to different target groups and settings with concrete implementation proposals.
Funding
This project is funded by German Cancer Aid (DKH).
Term: 2022-2025
Responsibility and Collaborative Partners
| Oncology / Medical Ethics | Ethics and Empirics | Health Economics |
| Heidelberg University Medical Faculty Heidelberg University Hospital National Center for Tumour Diseases | University Halle-Wittenberg Institute for the History and Ethics of Medicine University Medicine | University of Bielefeld Faculty of Health Sciences Health Economics and Health Management |
| Prof. Dr med. Dr phil. Eva Winkler, Dr Katja Mehlis, Dr Julia König MAE | Prof. Dr Jan Schildmann M.A., Sabine Sommerlatte, M. mel. | Prof. Dr Wolfgang Greiner Birthe Aufenberg, M. |
PUBLICATIONS
- Koenig JFL, Aufenberg B, Brei G, Reitmayer S, Sommerlatte S, Greiner W, Schildmann J, Winkler EC, Mehlis K. Financial influences and the primacy of patient welfare - an empirical and ethical analysis in German cancer medicine. BMC Med Ethics. 2026 May 6;27(1):100. doi: 10.1186/s12910-026-01450-2.
- König JFL, Aufenberg B, Brei G, Reitmayer S, Sommerlatte S, Greiner W, Schildmann J, Winkler EC, Mehlis K. How do financial considerations influence medical decision-making? A qualitative-empirical study in German cancer medicine. BMJ Public Health. 2025 Nov 27;3(2):e003346. doi: 10.1136/bmjph-2025-003346.