This paper focuses on local constructions of 'nature' in governance processes, and the importance of historical and institutional contexts for their genesis and functioning. Through extensive field study in the Romanian Danube Delta, it is demonstrated that the origin and distribution of certain concepts can be credited to a history of conflicts over land and resource use. Considering the implications for participatory natural resource governance, we argue that this capacity of the governance context to produce and transform concepts of nature, (...) poses real challenges. To these challenges can be added legacies of disempowerment and marginalisation, evident in local inhabitants' images and concepts of nature, which we seek to understand by developing a theory of traumatic nature. (shrink)

6 and 14 recently proposed taxonomies that distinguish between four processing states, based on bottom-up stimulus strength and top-down attentional amplification. The aim of the present study was to empirically test these processing states using the priming paradigm. Our results showed that attention and stimulus strength significantly modulated priming effects: either receiving top-down attention or possessing sufficient bottom-up strength was a prerequisite for a stimulus to elicit priming. When both top-down attention and sufficient bottom-up strength were present, the priming effect (...) was boosted. The origins of the observed priming effects also varied between different processing states. We can conclude that our empirical study using the priming paradigm confirmed the presence of four processing states, which displayed a differential pattern of response priming effects and differential origins of the response priming effects. (shrink)

Human body material removed post mortem is a particularly valuable resource for research. Considering the efforts that are currently being made to study the biochemical processes and possible genetic causes that underlie cancer and cardiovascular and neurodegenerative diseases, it is likely that this type of research will continue to gain in importance. However, post mortem procurement of human body material for research raises specific ethical concerns, more in particular with regard to the consent of the research participant. In this paper, (...) we attempt to determine which consent regime should govern the post mortem procurement of body material for research. In order to do so, we assess the various arguments that could be put forward in support of a duty to make body material available for research purposes after death. We argue that this duty does in practice not support conscription but is sufficiently strong to defend a policy of presumed rather than explicit consent. (shrink)

In 2017, the blockade of Qatar Gulf states caused a plethora of effects on the country. This paper sought to examine the resulting threat effects of this blockade in terms of lowered self-esteem and well-being, and the potential buffering effects of an overarching identity. Using self-report questionnaire data from Qatari secondary school students, multiple moderated mediation models investigated the predictive effects of youngsters’ perceived threat, via self-esteem, on their well-being, and the mitigating roles herein of, respectively, national, Gulf region, and (...) Arab identity. Perceived threat was indeed related to lower well-being via lower self-esteem, and this relationship was equally strong for those low and high in social identity. In terms of the three facets of identity, the overarching Gulf identity seems the most predictive, and it even buffers the negative relationship between threat and reduced self-esteem. (shrink)

Together with the city council elections, the citizens of Antwerp elected on 8 October 2000 nine district councils. This new decentralised political level is primarily initiated to restore the confidence of the citizens in the city government. By analysing the results of the city and the district elections we try to find indications whether citizens feel closer to their new district governments or not. Apparently district elections resulted neither in a higher voter turn-out, nor in less blank votes. Nevertheless, there (...) is a significant correlation of voter turn-out and blank votes with population of the districts. And although the differences between the electoral results of the city elections and the district elections are not huge, a different political landscape comes more or less into existence in the several districts. Quite surprisingly the number of list votes is higher on the district elections than on the city elections, while we would have expected a higher number of preferential votes. Correctingfor incumbents and famous candidates on the lists, our initial expectations hold much better. Generally spoken, we can conclude that the district elections do not give much proof of a closer connection between the citizens and the city government. Nevertheless we find some important differences between the districts. (shrink)

This report presents a comprehensive set of recommendations for protection of human beings who are trafficked for the purpose of organ removal or are targeted for such trafficking. Developed by an interdisciplinary group of international experts under the auspices of the project Trafficking in Human Beings for the Purpose of Organ Removal, these recommendations are grounded in the view that an individual who parts with an organ for money within an illegal scheme is ipso facto a victim and that the (...) crime of trafficking in human beings for the purpose of organ removal intersects with the crime of trafficking in organs. Consequently, the protection of victims should be a priority for all actors involved in antitrafficking activities: those combating organ-related crimes, such as health organizations and survivor support services, and those combating trafficking in human beings, such as the criminal justice sectors. Taking into account the special characteristics of THBOR, the authors identify 5 key stakeholders in the protection of human beings trafficked for organ removal or targeted for such trafficking: states, law enforcement agencies and judiciary, nongovernmental organizations working in the areas of human rights and antitrafficking, transplant centers and health professionals involved in transplant medicine, and oversight bodies. For each stakeholder, the authors identify key areas of concern and concrete measures to identify and protect the victims of THBOR. The aim of the recommendations is to contribute to the development of a nonlegislative response to THBOR, to promote the exchange of knowledge and best practices in the area of victim protection, and to facilitate the development of a policy-driven action plan for the protection of THBOR victims in the European Union and worldwide. (shrink)

Looking at a pair of objects is easy when automatic grouping mechanisms bind these objects together, but visual exploration can also be more flexible. It is possible to mentally “re-group” two objects that are not only separate but belong to different pairs of objects. “Re-grouping” is in conflict with automatic grouping, since it entails a separation of each item from the set it belongs to. This ability appears to be impaired in patients with schizophrenia. Here we check if this impairment (...) is selective, which would suggest a dissociation between grouping and “re-grouping,” or if it impacts on usual, automatic grouping, which would call for a better understanding of the interactions between automatic grouping and “re-grouping.” Sixteen outpatients with schizophrenia and healthy controls had to identify two identical and contiguous target figures within a display of circles and squares alternating around a fixation point. Eye-tracking was used to check central fixation. The target pair could be located in the same or separate hemifields. Identical figures were grouped by a connector (grouped automatically) or not (to be re-grouped). Attention modulation of automatic grouping was tested by manipulating the proportion of connected and unconnected targets, thus prompting subjects to focalize on either connected or unconnected pairs. Both groups were sensitive to automatic grouping in most conditions, but patients were unusually slowed down for connected targets while focalizing on unconnected pairs. In addition, this unusual effect occurred only when targets were presented within the same hemifield. Patients and controls differed on this asymmetry between within- and acrosshemifield presentation, suggesting that patients with schizophrenia do not re-group figures in the same way as controls do.We discuss possible implications on how “re-grouping” ties in with ongoing, automatic perception in healthy volunteers. (shrink)

In this article we investigate the value and utility of Machiavelli’s work for Community-Based Natural Resource Management. We made a selection of five topics derived from literature on NRM and CBNRM: Law and Policy, Justice, Participation, Transparency, and Leadership and management. We use Machiavelli’s work to analyze these topics and embed the results in a narrative intended to lead into the final conclusions, where the overarching theme of natural resource management for the common good is considered. Machiavelli’s focus on practical (...) realities produces new, sometimes unsettling, insights. We conclude that this focus helps to understand the development and performance of management regimes and their consequences and that institutional design should be seen as an ongoing process, which requires a constant adaptation of these institutions. (shrink)

The European Union affects the internal organisation of national political parties. We found 'traces of Europe' in the party statutes of all Belgian parties that are represented in the European Parliament since 1999. Europe is, to a greater or lesser extent, present in party goals, rules on party membership and party organs. Parties have elaborated rules for the organisation of European elections, for the selection of European executives, for the formulation of party programmes, and for internal and external co-ordination of (...) policy formulation. At first sight these rules seem to confirm the hypothesis that Europe is in the first place a concern of party leadership, and that it reinforces centralisation of decision-making. Yet the full confirmation of this hypothesis requires further comparative research on the Europeanisation of political parties. (shrink)

With the case of Belgium as a negative example, this paper will evaluate the legitimacy of using mentally incompetents as organ sources. The first section examines the underlying moral dilemma that results from the necessity of balancing the principle of respect for persons with the obligation to help people in desperate need. We argue for the rejection of a radical utilitarian approach but also question the appropriateness of a categorical prohibition. Section two aims to strike a fair balance between the (...) competing interests at stake and to define the conditions under which organ harvest from mentally incompetents might be morally acceptable. To this end, we morally assess the main requirements that have been put forward to allow organ removal from incompetent donors. We conclude that the current Belgian legislation is far too permissive and that national regulations that do not permit the harvest of non-regenerable organs from mentally incompetents in exceptional circumstances are too restrictive. On the basis of this discussion, we propose a number of guiding principles for decision-making in this area. (shrink)

On 19 December 2008 the Official Journal of Belgium published the ‘Law regarding the procurement and use of human body material destined for human medical applications or for scientific research purposes’. This paper will comment on various aspects of the Law: its scope of application (what is understood by ‘body material’?); its concept of ‘residual human body material’ (with far-reaching implications for the type of consent required for research); the nature of actions with and uses of human body material that (...) are explicitly prohibited; the right of donors to be informed of relevant information revealed by the use of their body material; and the special responsibilities placed on hospital ethics committees. As will be argued in this paper, several of these provisions are highly problematic from an ethical point of view, especially those relating to consent. Meanwhile, the Minister of Public Health has asked the Belgian Advisory Committee on Bioethics for advice on the incorporation of the ‘presumed consent’ model, that applies to post mortem organ donation, into the biobank Law’s provisions on post mortem removal and use of body material. This aspect of the Law effectively extends the ‘presumed consent’ regime, both from organs to body material in general, and from therapeutic uses to research uses. (shrink)

In 2012, a new and promising gene manipulation technique, CRISPR-Cas9, was announced that seems likely to be a foundational technique in health care and agriculture. However, patents have been granted. As with other technological developments, there are concerns of social justice regarding inequalities in access. Given the technologies’ “foundational” nature and societal impact, it is vital for such concerns to be translated into workable recommendations for policymakers and legislators. Colin Farrelly has proposed a moral justification for the use of patents (...) to speed up the arrival of technology by encouraging innovation and investment. While sympathetic to his argument, this article highlights a number of problems. By examining the role of patents in CRISPR and in two previous foundational technologies, we make some recommendations for realistic and workable guidelines for patenting and licensing. (shrink)

Notwithstanding fears of overly permissive approaches and related pleas to refuse euthanasia for psychological suffering, some Belgian hospitals have declared that such requests could be admissible. However, some of these hospitals have decided that such requests have to be managed and carried out outside their walls. Ghent University Hospital has developed a written policy regarding requests for euthanasia for psychological suffering coming from patients from outside the hospital. The protocol stipulates several due care criteria that go beyond the requirements of (...) the Belgian Euthanasia Law. For instance, the legally required first and second consulted physicians should all be psychiatrists and be affiliated with a psychiatry department of a Flemish university hospital. Moreover, euthanasia for psychological suffering can only be performed if the advices of these consulted physicians are positive. Importantly, preliminary reflection by the multidisciplinary Hospital Ethics Committee was introduced to discuss every request for euthanasia for psychological suffering coming from outside the hospital. In this way, the protocol supports psychiatrists faced with the complexities of assessing such requests, improves the quality of euthanasia practice by ensuring transparency and uniformity, and offers patients specialised support and guidance during their euthanasia procedure. Nevertheless, some concerns still remain. (shrink)

Theory and Practice of Knowledge Transfer: Studies in School Education in the Ancient Near East and Beyond. Edited by W. S. van Egmond and W. H. van Soldt. Publications de l’Institut histo- rique-archéologique néerlandais de Stamboul, vol. 121. Leiden: Nederlands Instituut voor het NabiJe Oosten, 2012. Pp. 111 + 152. €36.04.

Belgium is one of very few countries where euthanasia on the basis of psychiatric illness is legally possible. Three physicians involved in the euthanasia of a 38-year-old woman suffering from psychiatric illness recently faced a criminal trial for “murder by poisoning”, for allegedly having failed to comply with several requirements of the Belgian Euthanasia Law. Although none of the physicians were convicted, the case generated extensive debate, in the media and the general public as well as in the medical profession (...) and among policy makers. In this chapter, we take this trial as the starting point for a critical analysis of the clinical-psychiatric, ethical, and legal issues involved in evaluating euthanasia requests in cases of complex psychiatric disorders. In these cases, the requirements of the Belgian Euthanasia Law could be improved by mandating the advice of two psychiatrists, who are experts in the treatment of the specific condition of the person requesting euthanasia. Simultaneously with the process of evaluating the euthanasia request, there should be a parallel treatment track in which all therapeutic and recovery-oriented options are explored. These two tracks should not be in the hands of the same physician. (shrink)

Studying and discussing boundary violations between people is important for potentially averting future harm. Organizations typically respond to boundary violations in retributive ways, by punishing the perpetrator. Interestingly, prior research has largely ignored the impact of sexual boundary violations and retributive dynamics on teams. This is problematic as teams provide an obvious setting not only to detect and discuss troubling behavior by peers, but also for learning how to prevent future harm. Therefore, in this study we explore team-level experiences regarding (...) sexual boundary violations and organizational responses to these incidents. Drawing on an in-depth case study, our findings shed light on the profound negative consequences of a retributive organizational response to sexual boundary violations. Additionally, our findings show how a restorative approach, inviting teams to reflect on the violations and their impact, can help teams to recover. Our main contribution involves a model that demonstrates how the interplay between sexual boundary violations, retributive, and restorative organizational responses affects teams. This model shows how combining these responses can acknowledge distress within teams, heal relationships between team members through dialogue, and open up the possibility to learn from these events. This model extends prior research focusing on individual actions and outcomes regarding violations. Additionally, by combining retributive and restorative organizational responses in one model, we extend the literature on restorative organizational responses to boundary violations. (shrink)

There is considerable support for the idea that an atmosphere of safety can foster learning in groups, especially during ethics training courses. However, the question how safety dynamics works during ethics courses is still understudied. This article aims to investigate safety dynamics by examining a critical incident during a military ethics train-the trainer course during which safety was threatened. We examine this incident by means of a four-factor analysis model from the field of Theme-Centered Interaction (TCI). We show that during (...) ethics training courses a safety paradox can occur, involving a tension between honesty and openness to other perspectives and values. Finally, we discuss how trainers can foster safety during ethics training. (shrink)

Military employees face all sorts of moral dilemmas in their work. The way they resolve these dilemmas—how they decide to act based on their moral deliberations—can have a substantial impact both on society and on their personal lives. Hence, it makes sense to support military employees in dealing with these dilemmas. Military organizations already support their personnel by adopting compliance‐based approaches that focus, for instance, on enforcing moral rules. At the same time, however, they struggle to develop value‐based approaches that (...) could foster moral learning by improving employees' understanding of personal values, others' values, and their responsibility for others. Consequently, military employees are not adequately supported in their ethical decision‐making when confronted with complex situations. To address this issue, drawing on a design research approach, we develop and evaluate the use of a value‐based reflection tool to support military employees with their moral decision‐making. The design and evaluation of the value‐based reflection tool were informed by five semistructured interviews, notes on 45 joint reflection meetings with trainers, and evaluation notes of 755 participants. Our findings suggest the value‐based reflection tool is a promising way to foster actors' moral competence in organizational settings by triggering the social mechanisms of reflection, empathy, and psychological safety. This study is the first to illustrate that value‐based ethics support can complement compliance‐based ethics support in a military organization. Furthermore, it demonstrates design research's potential to develop actionable knowledge for ethics support practices in organizations. (shrink)

On 11 September 2019, the verdict was read in the first prosecution of a doctor for euthanasia since the Termination of Life on Request and Assisted Suicide Act of 2002 was installed in the Netherlands. The case concerned euthanasia on the basis of an advance euthanasia directive for a patient with severe dementia. In this paper we describe the review process for euthanasia cases in the Netherlands. Then we describe the case in detail, the judgement of the Regional Review Committees (...) for Termination of Life on Request and Euthanasia and the judgement of the medical disciplinary court. Both the review committees and the disciplinary court came to the conclusion there were concerns with this case, which mainly hinged on the wording of the AED. They also addressed the lack of communication with the patient, the absence of oral confirmation of the wish to die and the fact that the euthanasia was performed without the patient being aware of this. However, the doctor was acquitted by the criminal court as the court found she had in fact met all due care criteria laid down in the act. We then describe what this judgement means for euthanasia in the Netherlands. It clarifies the power and reach of AEDs, it allows taking conversations with physicians and the testimony of the family into account when interpreting the AED. However, as a practical consequence the prosecution of this physician has led to fear among doctors about prosecution after euthanasia. (shrink)

This intervention study examined the effects of a career crafting training on physicians' perceptions of their job crafting behaviors, career self-management, and employability. A total of 154 physicians working in two hospitals in a large Dutch city were randomly assigned to a waitlist control group or an intervention group. Physicians in the intervention group received an accredited training on career crafting, including a mix of theory, self-reflection, and exercises. Participants developed four career crafting goals during the training, to work on (...) in the subsequent weeks, after which a coaching conversation took place over the phone. Physicians in the control group received no intervention. A pre- and post-test 8 weeks later measured changes in job crafting and career self-management and employability of 103 physicians that completed the pre- and post-test. RM ANOVAs showed that the intervention enhanced perceptions of career self-management and job crafting behavior to decrease hindering job demands. No support was found for the effect of the intervention on other types of job crafting and employability. This study offers novel insights into how career crafting can be enhanced through training, as this is the first empirical study to examine a career crafting intervention. HR managers can use the outcomes to develop tailored career policies and career development practices. (shrink)

Schizophrenia is associated with a series of visual perception impairments, which might impact on the patients’ every day life and be related to clinical symptoms. However, the heterogeneity of the visual disorders make it a challenge to understand both the mechanisms and the consequences of these impairments, i.e., the way patients experience the outer world. Based on earlier psychiatry literature, we argue that issues regarding time might shed a new light on the disorders observed in patients with schizophrenia.We will briefly (...) review the mechanisms involved in the sense of time continuity and clinical evidence that they are impaired in patients with schizophrenia.We will then summarize a recent experimental approach regarding the coding of time-event structure in time, namely the ability to discriminate between simultaneous and asynchronous events. The use of an original method of analysis allowed us to distinguish between explicit and implicit judgments of synchrony.We showed that for SOAs below 20ms neither patients nor controls fuse events in time. On the contrary subjects distinguish events at an implicit level even when judging them as synchronous. In addition, the implicit responses of patients and controls differ qualitatively. It is as if controls always put more weight on the last occurred event, whereas patients have a difficulty to follow events in time at an implicit level. In patients, there is a clear dissociation between results at short and large asynchronies, that suggest selective mechanisms for the implicit coding of time-event structure. These results might explain the disruption of the sense of time continuity in patients.We argue that this line of research might also help us to better understand the mechanisms of the visual impairments in patients and how they see their environment. (shrink)

The modern critical approach to things hagiographical still wavers when it comes to taking leave of twelve lines of iambic invective, branded with wonderful delicacy of touch on the saintly foreheads of two Palestinian brothers, Theodore and Theophanes, the so-called “Graptoi”. Barry Baldwin, noting that C.A. Trypanis, unlike the great B. Bury and others, was inclined to disbelieve the story, could not help expressing the hope that it was true (An Anthology of Byzantine Poetry, Amsterdam 1985, pp. 142–3). It is (...) of course only one of the many stories concocted by iconodule propaganda. The central question has to be formulated in more general terms: how is history made? History here primarily in the sense of the construction of the past by the Byzantines themselves, was embodied in historical narratives moving between hagiography and historiography. Trying to lay bare the basis and elements of such constructs will always remain a major task of critical historical scholarship. (shrink)

Ethics training has become a common phenomenon in the training of military professionals at all levels. However, the perceived outcomes of this training remain open. In this article, we analyze the experiences of course participants who were interviewed 6–12 months after they had participated in a train-the-trainer course in military ethics developed by the Faculty of Military Sciences of the Netherlands Defence Academy. Through qualitative inductive analysis, it is shown how participants evaluate the training, how they perceive the development of (...) their moral competence, and how they see the impact of the training on their own training practice. (shrink)

Due to huge advancements in natural language processing (NLP) and machine learning, chatbots are gaining significance in the field of customer service. For users, it may be hard to distinguish whether they are communicating with a human or a chatbot. This brings ethical issues, as users have the right to know who or what they are interacting with (European Commission in Regulatory framework proposal on artificial intelligence. https://digital-strategy.ec.europa.eu/en/policies/regulatory-framework-ai, 2022). One of the solutions is to include a disclosure at the start (...) of the interaction (e.g., “this is a chatbot”). However, companies are reluctant to use disclosures, as consumers may perceive artificial agents as less knowledgeable and empathetic than their human counterparts (Luo et al. in Market Sci 38(6):937–947, 2019). The current mixed methods study, combining qualitative interviews (n = 8) and a quantitative experiment (n = 194), delves into users’ responses to a disclosed vs. undisclosed customer service chatbot, focusing on source orientation, anthropomorphism, and social presence. The qualitative interviews reveal that it is the willingness to help the customer and the friendly tone of voice that matters to the users, regardless of the artificial status of the customer care representative. The experiment did not show significant effects of the disclosure (vs. non-disclosure). Implications for research, legislators and businesses are discussed. (shrink)

The prevalence of Clinical ethics support services is increasing. Yet, questions about what quality of CES entails and how to foster the quality of CES remain. This paper describes the development of a national network, which aimed to conceptualize and foster the quality of CES in the Netherlands simultaneously. Our methodology was inspired by a responsive evaluation approach which shares some of our key theoretical presuppositions of CES. A responsive evaluation methodology engages stakeholders in developing quality standards of a certain (...) practice, instead of evaluating a practice by predefined standards. In this paper, we describe the relationship between our theoretical viewpoint on CES and a responsive evaluation methodology. Then we describe the development of the network and focus on three activities that exemplify our approach. In the discussion, we reflect on the similarities and differences between our approach and other international initiatives focusing on the quality of CES. (shrink)

PurposeThis paper aims to demonstrate the relevance of worldviews of the global south to debates of artificial intelligence, enhancing the human rights debate on artificial intelligence (AI) and critically reviewing the paper of UNESCO Commission on the Ethics of Scientific Knowledge and Technology (COMEST) that preceded the drafting of the UNESCO guidelines on AI. Different value systems may lead to different choices in programming and application of AI. Programming languages may acerbate existing biases as a people’s worldview is captured in (...) its language. What are the implications for AI when seen from a collective ontology? Ubuntu (I am a person through other persons) starts from collective morals rather than individual ethics.Design/methodology/approachLiterature overview on the African philosophy of Ubuntu as applied to artificial intelligence. Application of it to the United Nations Educational, Scientific and Cultural Organisation (UNESCO) debates on establishing guidelines to the ethics of artificial intelligence.FindingsMetaphysically, Ubuntu and its conception of social personhood (attained during one’s life) largely rejects transhumanism. When confronted with economic choices, Ubuntu favors sharing above competition and thus an anticapitalist logic of equitable distribution of AI benefits, humaneness and nonexploitation. When confronted with issues of privacy, Ubuntu emphasizes transparency to group members, rather than individual privacy, yet it calls for stronger (group privacy) protection. In democratic terms, it promotes consensus decision-making over representative democracy. Certain applications of AI may be more controversial in Africa than in other parts of the world, like care for the elderly, that deserve the utmost respect and attention, and which builds moral personhood. At the same time, AI may be helpful, as care from the home and community is encouraged from an Ubuntu perspective. The report on AI and ethics of the UNESCO World COMEST formulated principles as input, which are analyzed from the African ontological point of view. COMEST departs from “universal” concepts of individual human rights, sustainability and good governance which are not necessarily fully compatible with relatedness, including future and past generations. Next to rules based approaches, which may hamper diversity, bottom-up approaches are needed with intercultural deep learning algorithms.Research limitations/implicationsThere is very few existing literature on AI and Ubuntu. Therefore, this paper is of an explorative nature.Practical implicationsThe ethics of Ubuntu offers unique vantage points in looking at the organization of society and economics today, which are also relevant for development of AI, especially in its tenet of relatedness rather than individuality (and practical use of AI for individuals), taking responsibility for society as a whole (such as analyzing the benefit of AI for all strata of society), and embodying true inclusiveness. Whether looking at top-down guidelines for the development and implementation of AI or the bottom-up ethical learning process of AI (deep learning), ethics of the Global South can have an important role to play to combat global individualist tendencies and inequity, likely reinforced by AI. This warrants far more research.Social implicationsApplications of AI in Africa are not contextualized, do not address the most pressing needs of the African continent, lead to cybersecurity issues and also do not incorporate African ethics. UNESCO’s work in this regard is important but expert inputs are largely centered around Western “universal” principles and Organisation for Economic Cooperation and Development and EU precedence. African ethics have, so far, a small role to play in global ethics and philosophy and therefore risk to be overlooked in the discussion on AI and ethics. This is why the consultation process of UNESCO on ethics of AI was of paramount importance. However, it does not automatically lead to consultation of African philosophers or sages, as many are educated in Western (ized) education systems. See further details under practical implications.Originality/valueThis is a new area of research in which little work has been done so far. This paper offers the opportunity to widen the debate on AI and ethics beyond the conventional discourse, involving multiple worldviews, of which Ubuntu is just one. (shrink)

Appraisal theories of emotions have gained widespread acceptance in the field of emotion research (for a recent overview, see, e.g., Scherer, Schorr, & Johnstone, 2001). In these theories, it is as...

BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES (...) practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions.ResultsThe main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices.ConclusionsThe evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA. (shrink)