Aim:This study explores experiences of patients suffering from Korsakoff’s syndrome. It contributes to improved reflection on the value of patient knowledge.Background:An ethics of care perspective states the importance of moving to patients in their vulnerable state of being, and to figure out patients’ individual needs necessary to provide good care. The information given by patients suffering from Korsakoff’s syndrome might be mistaken, invented and even not true. The value of these patients’ experiences and knowledge had not been researched to date.Method:Data (...) from six in-depth interviews were analysed concurrently through the constant comparative method.Ethical considerations:The principles of voluntariness, confidentiality and anonymity were respected during the research process.Findings:Four important themes within patients’ knowledge emerged: health condition, involuntary admission into the nursing home, the daily routine and interpretation of the caring abilities of healthcare professionals. The findings show that our respondents were able to provide a window into their inner perspective.Conclusion:This study deepens our understanding of the value of patient knowledge in situations where patients see the world in a different manner as do healthcare professionals. The conversations revealed personal subjective knowledge which our respondents create and live by. Healthcare professionals are encouraged to discover and affirm the understandings of these patients, and not be prepossessed due to the diagnosis or general nursing home rules. Understanding patients’ unique knowledge through appreciation of the complexity and richness of different views on the situation can assist to give a more humane response to individual needs and pain. Health staff in healthcare institutions are encouraged to evaluate the – unintended – effect of rigidly applied nursing home rules, and the government is challenged to rethink its policy about care, and provide more resources permitting relational care that nurtures the dignity of patients suffering from Korsakoff’s syndrome. (shrink)

Patient’s decision making competence is a widely discussed subject. Issues of competence, autonomy, well-being and protection of the patient come up every day. In this article we analyse what role PDMC plays in Dutch legislation and what dilemmas healthcare professionals may experience, notably in patients suffering from Korsakoff’s syndrome. Dilemmas emerge if professionals want to meet the requirements mentioned in Dutch law and the desires of their patients. The autonomy of the patient and the healthcare professionals’ duty to take care (...) of their patient’s best interests, create a tension and lead to uncomfortable situations. Healthcare professionals describe difficulty finding a balance between these issues and assessing the degree of mental competence still present. In long term care situations, quality of the relationship between healthcare professionals and their patients seems to be of much more importance in decision making on minor issues of competence than simply relying on legal or house rules. In being committed to their cases, professionals will be more sensitive to individuals habits, abilities, welfare and dignity, which will make it easier to decide on issues of competence, and to find creative solutions to their dilemmas. (shrink)

The main objective of this paper is to describe how quality of care may be improved during an involuntary admission process of patients suffering from Korsakoff's syndrome. It presents an empirically grounded analysis with different perspectives on ‘doing good’ during this process. Family carers', healthcare professionals' and legal professionals' ways of understanding and ordering this problematic situation appear very different. This could prevent patients from getting the proper care they need, with risk of more suffering and quality of life below (...) the minimum acceptable. All this possibly lead to immoral dehumanizing situations. Firstly, the background of our empirical study is sketched. Secondly, the different perspectives on ‘doing good’ are summarized and compared. Thirdly, the tensions arising from the different conceptualizations of autonomy and different types of responsibilities of the actors are clarified. A common ‘doing good’ during involuntary admission necessitates removal of any tensions within the relational network by weighing and balancing the different perspectives on autonomy and the resulting responsibilities. With this in mind, we propose a renewed time/action table for involuntary admission, which tends to address all patients' needs at the right time. The solution presented might help healthcare professionals, who are squeezed in between patients, family carers, legal professionals and overall rules, to create practices in which patients suffering from Korsakoff's syndrome can maintain their dignity and receive the care they need. Earlier interventions, timely and adequate diagnosis, and diminishment of tensions between the different actors by fine‐tuning their paradigmatic frameworks are suggested to be part of a solution. (shrink)

Name der Zeitschrift: Neue Zeitschrift für Systematische Theologie und Religionsphilosophie Jahrgang: 57 Heft: 1 Seiten: 138-154.

Two areas of research for testing Nell's theory are suggested. One is cruelty's seemingly negative correlation with age, which would confirm its linkage with testosterone, sex, and dominance. The other is the special field of leisure activity called thanatourism, that is, the transformation of loci of human horror into tourist attractions.

Chervenak and McCullough, authors of the most acknowledged ethical framework for maternal–fetal surgery, rely on the ‘ethical–obstetrical’ concept of the fetus as a patient in order to determine what is morally owed to fetuses by both physicians and the women who gestate them in the context of prenatal surgery. In this article, we reconstruct the argumentative structure of their framework and present an internal criticism. First, we analyse the justificatory arguments put forward by the authors regarding the moral status of (...) the fetus qua patient. Second, we discuss the internal coherence and consistency of the moral obligations those authors derive from that concept. We claim that some of the dilemmas their approach is purported to avoid, such as the debate about the independent moral status of the fetus, and the foundation of the moral obligations of pregnant women (towards the fetuses they gestate) are not, all things considered, avoided. Chervenak and McCullough construct the obligations of physicians as obligations towards entities with equal moral status. But, at the same time, they assume that the woman has an independent moral status while the moral status of the fetus is dependent on the decision of the woman to present it to a physician for care. According to the logic of their own argumentation, Chervenak and McCullough implicitly admit a different moral status of the woman and the fetus, which will lead to different ascription of duties of the physician than those they ascribed. (shrink)

This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception about the nature of clinical research and the status of research subjects. Second, given that it is not clear who the research subject/s in MFS is/are, if clinical equipoise is to be used as a (...) criterion to test the ethical appropriateness of RCT, its meaning should be unambiguous. Third, because of the multidisciplinary character of MFS, it is not clear who should be in equipoise. As a result, we lack an adequate criterion for the ethical review of MFS protocols. In our account, which is based on Chervenak and McCullough's seminal work in the field of obstetric ethics, equipoise is abandoned. and RCT involving MFS can be ethically initiated when a multidisciplinary ethics review board (ERB), having an evidence-based assessment of the risks involved, is convinced that the value of answering the research hypothesis, for the sake of the health interests of future pregnant women carrying fetuses with certain congenital birth defects, justifies the actual risks research participants might suffer within a set limit of low/manageable. (shrink)

Much clinical and ethnographic evidence suggests that humans, like many other organisms, are selected to avoid close inbreeding because of the fitness costs of inbreeding depression. The proximate mechanism of human inbreeding avoidance seems to be precultural, and to involve the interaction of genetic predispositions and environmental conditions. As first suggested by E. Westermarck, and supported by evidence from Israeli kibbutzim, Chinese sim-pua marriage, and much convergent ethnographic and clinical evidence, humans negatively imprint on intimate associates during a critical period (...) of early childhood.There is also much evidence that, like other social animals, humans do not seek to maximize outbreeding, but rather to maintain an optimal balance between outbreeding and inbreeding.Closeinbreeding reduces fitness through inbreeding depression, butsomeinbreeding brings the benefits of nepotism. For simple, stateless, horticultural societies, the optimal balance seems to be achieved by a combination of precultural inbreeding avoidance of relatives with anr≤·25 and cultural rules of preferential marriage with kin withr≥·25. Adjustment of the coefficient of inbreeding to other ecological settings seems to be largely cultural. An interactive model of “culture in nature” is presented, in which culture is seen as coevolving with genes to produce the maxiniization of individual inclusive fitness. (shrink)

Patient-reported outcomes are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts and dispositions. We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. If influences of response (...) shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used. (shrink)

The COVID-19 pandemic has forced developmental researchers to rethink their traditional research practices. The growing need to study infant development at a distance has shifted our research paradigm to online and digital monitoring of infants and families, using electronic devices, such as smartphones. In this practical guide, we introduce the Experience Sampling Method – a research method to collect data, in the moment, on multiple occasions over time – for examining infant development at a distance. ESM is highly suited for (...) assessing dynamic processes of infant development and family dynamics, such as parent-infant interactions and parenting practices. It can also be used to track highly fluctuating family dynamics and routines. The aim of the current paper was to provide an overview by explaining what ESM is and for what types of research ESM is best suited. Next, we provide a brief step-by-step guide on how to start and run an ESM study, including preregistration, development of a questionnaire, using wearables and other hardware, planning and design considerations, and examples of possible analysis techniques. Finally, we discuss common pitfalls of ESM research and how to avoid them. (shrink)

We prove linear and polynomial growth properties of sets and functions that are existentially definable in the ordered group of integers with divisibility. We determine the laws of addition with order and divisibility.

The first quodlibetal question by William of Alnwick is a reply to John Duns Scotus' Quaestio de Formalitatibus, where the latter clarified his understanding of the formal distinction: ‘formal non-identity’ of the personal properties in God (and of the divine attributes) does not preclude a formal distinction if the latter is conceived as a distinction weakened by the modifier ‘formal’. Whereas Scotus' Quaestio has been subjected to a detailed analysis by Stephen Dumont, “Duns Scotus’ Parisian Question”, there is as yet (...) no such analysis of Alnwick's response. In the present paper his position is explained in detail. Alnwick rejects Scotus' view of ‘formal’ as a weakening modifier; he argues that the formal distinction necessarily is unqualified and may still import too much of unwanted realism in the matter at hand. Both Scotus and Alnwick acknowledge that the formal non-identity reflects the nature of things without falling back to a real distinction. But for Alnwick the right kind of distinction is a qualified distinction that is not a formal distinction. (shrink)

Background and aim With the increasing interest in lifestyle, health and consequences of unhealthy lifestyles for the healthcare system, a new kind of solidarity is gaining importance: lifestyle solidarity. While it might not seem fair to let other people pay for the costs arising from an unhealthy lifestyle, it does not seem fair either to punish people for their lifestyle. However, it is not clear how solidarity is assessed by people, when considering disease risks or lifestyle risks. The aim of (...) this study was to investigate the degree of solidarity with lifestyle as well as with other factors that are related to health outcomes—for example, old age—and the relation between this degree of solidarity and various characteristics. Methods This cross-sectional study is part of the Dutch longitudinal SMILE study. Data on the degree of solidarity with different lifestyles and old age, and the relation between the degree of solidarity and various demographic and other variables were obtained in a questionnaire survey. Results Solidarity with smokers and overweight people was moderate, as was solidarity with older people. Respondents were ambivalent about athletes. Respondents who were younger, male and highly educated, and those with a healthy lifestyle, a small social network, high quality of life and an internal locus of control, showed low solidarity. Conclusions Solidarity with an unhealthy lifestyle and old age is moderate and the degree of solidarity varies among the different subgroups. (shrink)

Two areas of research for testing Nell's theory are suggested. One is cruelty's seemingly negative correlation with age, which would confirm its linkage with testosterone, sex, and dominance. The other is the special field of leisure activity called thanatourism, that is, the transformation of loci of human horror into tourist attractions.

Mental models influence how individuals think and act in relation to their external environment and have been identified as leverage points to address sustainability challenges. Given the importance of mental models, a new tool to assess mental models has been developed: the Mental Model Mapping Tool. M-Tool was designed to have a standardized format and to be user-friendly for low literacy populations, using pictograms and audio instructions. In this paper, we evaluate M-Tool’s application in two studies with Tanzanian fishers. In (...) Study 1, we investigated M-tool’s convergent validity compared to standard interviewing methods. Study 2 investigated M-Tool’s construct validity by relating mental model complexity to participants’ education level, a relationship that has been well established. The findings show that mental models produced with M-Tool are more complex than mental models obtained through interviewing techniques; model composition is similar across the two methods; and participants with higher levels of education tend to produce more complex mental models with M-Tool than participants with lower levels of education, in line with previous research. These findings suggest that M-Tool can successfully capture mental models among diverse participants. This tool offers researchers and practitioners an instrument to map and compare perceptions of challenges across groups. (shrink)

Prenatal expectations about what children will be like after birth may provide a context for how parents perceive their infant's actual temperament. We examined how these expectations and perceptions are associated and together predict early parenting behavior, with parenting behavior in turn predicting changes in temperament. Reports of 125 families about their expectations of their unborn child's temperament, their infant's temperament at 4 and 12 months post-partum, and their hostile, responsive, warm, and overprotective parenting were included. We also included data (...) from an independent sample of 168 mothers, with the same measures, except that mothers reported on Big Five personality traits at T1. Results indicated that in both samples, parents' expectations were positively associated with perceptions of infant temperament. Prenatal expectations and newborn temperament independently predicted parenting behavior, and maternal and paternal parenting in turn predicted infant temperament at T3, controlling for infant temperament at T2. Although overall findings indicated associations between a more difficult temperament and more negative/less positive parenting, significant combinations of specific traits and parenting behaviors were sample-specific—indicating that more research is necessary to draw a conclusion about specific links. Both maternal and paternal expectations about their unborn child's temperament appear to carry over into the postpartum reality and provide a context for shaping early interactions between caregivers and their children, which may further shape the developing temperament of the child. (shrink)

We prove linear and polynomial growth properties of sets and functions that are existentially definable in the ordered group of integers with divisibility. We determine the laws of addition with order and divisibility.

Nothing is gained by opposing and or by proclaiming the supremacy of one over the other. Instead, we should develop a unitary model of gene-culture coevolution, allowing for the complex interaction of both, and varying importance of each, all within our double, species-specific, adaptive, evolutionary track.

Dutch investigators continue to play a key role in animal behavior studies today . The present collection of current Dutch writings on animal consciousness ...