Introduction: In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion similarly was evaluated. Methods: 300 GPs, 150 consultants and 27 members of review committees were sent a questionnaire with patient descriptions. Besides a “standard case” of a patient with physical suffering and limited life expectancy, the descriptions included cases in (...) which the request was mainly rooted in psychosocial or existential suffering, such as fear of future suffering or dependency. For each case, respondents were asked whether they recognised the case from their own practice and whether they considered the suffering to be unbearable. Results: The cases were recognisable for almost all respondents. For the “standard case” nearly all respondents were convinced that the patient suffered unbearably. For the other cases, GPs thought the suffering was unbearable less often (2–49%) than consultants (25–79%) and members of the euthanasia review committees (24–88%). In each group, the suffering of patients with early dementia and patients who were “tired of living” was least often considered to be unbearable. Conclusions: When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient’s suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia. (shrink)

Newborn screening involves a complex logistical process, which depends on the close cooperation of many professionals, such as midwives, laboratory technicians, general practitioners and pediatricians. These professionals may encounter moral problems in the process, which have not been systematically studied before. This study fills this gap. We conducted interviews with 36 professionals involved in NBS in the Netherlands and made an inventory of the moral problems they encounter, as well as of the ways in which they tend to respond to (...) them. The moral problems professionals encounter stem from interpersonal conflicts and intrapersonal conflicts. Given the complexity of the work of NBS professionals, the study suggests that the moral problems that occur on the work floor cannot easily be solved by means of offering better or more stringent policy guidelines. Rather, it should be appreciated that professionals contribute significantly to shaping the morality of NBS with the help of their daily choices, and they should be supported in carrying out this task—for example with the help of a moral training or regular multidisciplinary moral deliberation, facilitated by an ethicist. (shrink)

"This book contains ideas to develop interdisciplinary and transdisciplinary views on economy and society. It aims to disseminate heterodox ideas on various subjects related to economics and global society. The book is organised in six parts. Part 1 contains the key lectures of Backhaus on the concept of state sciences and of Klamer on the importance of culture for economics. Parts 2- 6 contain successively contributions in the areas of economic paradigms and theories, population and society, corporate issues, environment, and (...) international relations. Examples of the content are: - the changes of family life cycles due to the rise of non-traditional households; - subjective and objective inflation rates after the introduction of the Euro; - the economics of genetic engineering; - the contribution of foreign direct investment to the economic development of host countries; - the inaccuracy of economic models applied in places characterized by extreme income disparities; - the improvement of political and corporate governance; - evolutionary thinking and emission trading; - freedom and order in the European Union; - the reform of social policy in Europe. The book provides interesting creative multi-disciplinary ideas with respect to various topical issues concerning the contemporary global society. It is highly recommended for economists and social scientists in search of broad views on social science and society.". (shrink)

BackgroundAs moral case deliberations (MCDs) have increasingly been implemented in health care institutions as a form of ethics support, it is relevant to know whether and how MCDs actually contribute to positive changes in care. Insight is needed on what actually happens in daily care practice following MCD sessions. This study aimed at investigating the impact of MCD and exploring how ‘impact of MCD’ should be conceptualized for future research.MethodsA multiple-case study was conducted in a care organization for people with (...) intellectual disabilities and/or acquired brain injury, by observing MCD sessions as ‘cases’, followed by interviews with health care professionals concerning the follow-up to these cases, and a focus group with involved MCD facilitators. A conceptual scheme concerning the possible impact formed the basis for analysis: (1) individual moral awareness; (2) the actions of health care professionals; (3) collaboration among health care professionals; (4) the concrete situation of the client; (5) the client’s quality of care and life; (6) the organizational and policy level.ResultsAccording to interviewees, their moral awareness and their collaboration, both among colleagues and with clients’ relatives, improved after MCD. Perceived impact on client situation, quality of care/life and the organizational level varied among interviewees or was difficult to define or link to MCD. Three aspects were added to the conceptual scheme concerning the impact of MCD: (a) preparations and expectations prior to the MCD session; (b) a translational step between the conclusions of the MCD session and practical events in the following period, and (c) collaboration with clients’ relatives. A negative impact of MCD was also found on misunderstandings among participants and disappointment about lack of follow-up.ConclusionsConcretizing and conceptualizing the ‘impact’ of MCD is complicated as many factors play a role either before or during the transition from MCD to practice. It is important to consider ‘impact’ in a broad sense and to relate it to the goals and context of the MCD in question. Future studies in this field should pay additional attention to the preparations, content and process involved in ethics support, including clients’ and relatives’ experiences. (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)

In this paper the authors give a survey of biological phenomena , for which the term ‘differentiation’, used in the widest sense, has a meaningful application. The last chapter deals with some general aspects of differentiation and connected phenomena, such as polarity, symmetry, loss of potencies, dedifferentiation, redifferentiation, adifferentiation, regulation and integration.To prevent this article becoming too voluminous, the authors had to refrain from extending the treatment of differentiation to non-living matter and to human society.

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

The COVID-19 lockdown has significantly disrupted the higher education environment within the Netherlands and led to changes in available study-related resources and study demands of students. These changes in study resources and study demands, the uncertainty and confusion about educational activities, the developing fear and anxiety about the disease, and the implementation of the COVID-19 lockdown measures may have a significant impact on the mental health of students. As such, this study aimed to investigate the trajectory patterns, rate of change, (...) and longitudinal associations between study resources–demands and mental health of 141 university students from the Netherlands before and during the COVID-19 lockdown. The present study employed a longitudinal design and a piecewise latent growth modeling strategy to investigate the changes in study resources and mental health over a 3 month period. The results showed that moderate levels of student resources significantly decreased before, followed by a substantial rate of increase during, lockdown. In contrast, study demands and mental health were reported to be moderate and stable throughout the study. Finally, the growth trajectories of study resources–demands and mental health were only associated before the lockdown procedures were implemented. Despite growing concerns relating to the negative psychological impact of COVID-19 on students, our study shows that the mental health during the initial COVID-19 lockdown remained relatively unchanged. (shrink)

Virtue ethics has emerged as a distinct field within moral theory - whether as an alternative account of right action or as a conception of normativity which departs entirely from the obligatoriness of morality - and has proved itself invaluable to many aspects of contemporary applied ethics. Virtue ethics now flourishes in philosophy, sociology and theology and its applications extend to law, politics and bioethics. 'The handbook of virtue ethics' brings together leading international scholars to provide an overview of the (...) field. Each chapter summarizes and assesses the most important work on a particular topic and sets this work in the context of historical developments. Taking a global approach by embracing a variety of major cultural traditions along with the Western, the handbook maps the emergence of virtue ethics and provides a framework for future developments. (shrink)

In this paper, we examine how organizations’ impression management evolves in response to rising stakeholder pressures regarding organizations’ corporate responsibility initiatives. We conducted a comparative case study analysis over a period of 13 years for two organizations—Exxon and BP—that took extreme initial stances on climate change. We found that as stakeholder pressures rose, their IM tactics unfolded in four phases: advocating the initial stance, sensegiving to clarify the initial stance, image repairing, and adjusting the stance. Taken together, our analysis of (...) IM over these four phases provides three key insights about the evolution of IM in the face of rising pressures. First, when faced with stakeholder pressures, it seems that organizations do not immediately resort to conforming but tend to give in gradually when pressures increase and start to come from relatively powerful stakeholders. Second, evolution of IM seems to be characterized by path dependence, i.e., even as organizations’ positions evolve, they continue to show their conviction in their initial positions and try to convey that their subsequent positions flow logically from the previous ones. Finally, IM involves navigation between symbolism and substance, and companies tend to strive toward harmonizing their symbolic and substantive actions as stakeholder pressure increases. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 61.3 (2000) 381-395 [Access article in PDF] Minds, Forms, and Spirits: The Nature of Cartesian Disenchantment Han van Ruler What is Descartes's contribution to Enlightenment? Undoubtedly, Cartesian philosophy added to the conflict between philosophical and theological views which divided intellectual life in the Dutch Republic towards the end of its "Golden Age." 1 Although not everyone was as explicit as Lodewijk Meyer, who (...) said that his theological doubts were inspired by Descartes's philosophical method, Cartesianism along with Copernicanism, Socinianism, and Cocceianism played an important part in the growing skepticism towards the authority of Scripture. 2 Apart from Descartes's general method, however, specific Cartesian ideas encouraged a new view towards nature and towards God's role in governing it. In physics and physiology the new philosophy replaced the image of mind working on matter with the image of a self sufficient mechanism. This new causal metaphor led to a typically Cartesian form of "disenchantment." In this article I argue that on account of their approval of a Cartesian theory of causality, even authors with sincere religious motives came close to accepting radical and nearly Spinozistic ideas. I start with disenchantment in a very literal sense: Balthasar Bekker's denial of the activities of devils, angels, and other spirits. A comparison of Bekker's arguments with those of another Cartesian, Arnold Geulincx will, I hope, bring out the nature and importance of what I shall present as [End Page 381] Descartes's "mechanical reduction" in physics. Finally, I argue that the Cartesian separation of mind and body gave rise to a form of disenchantment that reached far beyond contemporary debates. Devils, Ghosts, and God's Omnipotence Balthasar Bekker's classic book The World Bewitched (1691-93) does not so much deal with the practice of sorcery as with its theory. Bekker offers a wide range of theological and philosophical arguments in order to combat the idea that ghosts, devils, and angels influence natural or historical events. In particular Bekker draws some important conclusions from the philosophy of Descartes. Yet it is immediately clear to the reader that the motives for his critique are religious rather than philosophical. 3 The World Bewitched is not written as a scientific assault on superstition. Bekker, at the time serving as a Calvinist minister in Amsterdam, presents his work as a new and perhaps final phase in the perfection of Christianity. For two centuries it had been a goal of the Protestant Reformation to accentuate God's majesty and to establish the idea of His absolute power over creation. Bekker's World again expresses this idea. His denial that ghosts and devils are active in the world is a logical consequence of the belief that there is no room for demigods in nature. Bekker thus adds a final touch to the project of the Reformation. The World Bewitched will testify to the fact "that I return as much of the honor of His Power and Wisdom to the Almighty, as they took from Him who gave it to the Devil. I ban [the Devil] from the World and I bind him in Hell." 4 Removing devils and spirits from nature, Bekker aims to distinguish superstition from true faith. The battle against superstitious beliefs had formed a characteristic element of Protestant tactics. Dutch Calvinists, for instance, took offense at the continuing practices of blessings and incantations. 5 Bekker wanted to go even further. The Protestantization of Christian dogma could only be completed by making everything in nature's course depend on God's unique power and providence. 6 "Science" in our sense of the word was a subsidiary matter. 7 Still, Bekker saw the new scientific theories of his day as useful allies. In particular it was the new philosophy of Descartes that attracted him. Following Descartes, Bekker reasons "that I think, that I will, [End Page 382] [and] that I understand something," without any part of my body being involved in this type of consciousness. Mind and body in fact have nothing in common: My... (shrink)

Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder, and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient’s autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded in clinical (...) practice and corresponds with the experiences of patients with obsessions and/or compulsions. We present a naturalistic case study giving both the patient’s and the therapist’s perspective based on in-depth interviews and a narrative analysis. The case study shows that competence is not merely an assessment by a therapist, but also a co-constructed reality shaped by the experiences and stories of patient and therapist. The patient, a medical student, initially told her story in a restitution narrative, focusing on cognitive rationality. Reconstructing the history of her disease, her story changed into a quest narrative where there was room for emotions, values and moral learning. This fitted well with the therapist’s approach, who used motivational interventions with a view to appealing to the patient’s responsibility to deal with her condition. We conclude that in practice both the patient and therapist used a quest narrative, approaching competence as the potential for practical reasoning to incorporate values and emotions. (shrink)

The participation of vulnerable patients in clinical research poses apparent ethical dilemmas. Depending on the nature of the vulnerability, their participation may challenge the ethical principles of autonomy, non-maleficence, or justice. On the other hand, non-participation may preclude the building of a knowledge base that is a prerequisite for defining the optimal clinical management of vulnerable patients. Such clinical uncertainty may also incur substantial economic costs. We present the participation of pre-menopausal women with atrial fibrillation in trials of novel oral (...) anticoagulant drugs as a case study. Due to their non-participation in pivotal trials, it is uncertain whether for them, the risks that are associated with these drugs are outweighed by the advantages compared with conventional treatment. We addressed the question whether research of this new class of drugs in this subgroup would be appropriate from both, an ethical as well an economic perspective. We used the method of specifying norms as a wider framework to resolve the apparent ethical dilemma, while incorporating the question whether research of oral anticoagulants in premenopausal women with atrial fibrillation can be justified on economic grounds. For the latter, the results of a value-of-information analysis were used. Further clinical research on NOACs in premenopausal women with atrial fibrillation can be justified on both, ethical and economic grounds. Addressing apparent ethical dilemmas by invoking a method such as specifying norms can improve the quality of public practical reasoning. As such, the method should also prove valuable to committees that have formally been granted the authority to review trial protocols and proposals for scientific research. (shrink)

This article discusses Descartes’s preferred focus on morally and theologically neutral subjects and points out the impact of this focus on the scientific status of theology. It does so by linking Descartes’s method to his transformation of the notion of substance. Descartes’s _Meditations_ centred around epistemological questions rather than non-human intelligences or the life of the mind beyond this world. Likewise, in his early works, Descartes consistently avoided referring to causal operators. Finally, having first redefined the notion of substance in (...) the _Principia,_ Descartes would completely abandon making use of this notion in his later years. Indeed, in contrast to many authors before and after him, Descartes never showed any interest in the long-established metaphysical interpretation of substances as being causal factors of natural change. With God, nature, and mind commonly serving as instances of substantial causality, Descartes’s philosophy had a huge impact on the place of God in science and discreetl. (shrink)