Many previous treatments of voluntary behavior have viewed intentions as causes of behavior. This has resulted in several dilemmas, including a dilemma concerning the origin of intentions. The present article circumvents traditional dilemmas by treating intentions as constraints that restrict degrees of freedom for behavior. Constraints self-organize as temporary dynamic structures that span the mind-body divide. This treatment of intentions and voluntary behavior yields a theory of intentionality that is consistent with existing findings and supported by current research.

The method of positron emission tomography illustrates the circular logic popular in subtractive neuroimaging and linear reductive cognitive psychology. Both require that strictly feed-forward, modular, cognitive components exist, before the fact, to justify the inference of particular components from images after the fact. Also, both require a "true" componential theory of cognition and laboratory tasks, before the fact, to guarantee reliable choices for subtractive contrasts. None of these possibilities are likely. Consequently, linear reductive analysis has failed to yield general, reliable, (...) componential accounts. (shrink)

Models are not adequately evaluated simply by whether they capture the data, after the fact. Other criteria are needed. One criterion is parsimony; but utility and generality are at least as important. Even with respect to parsimony, however, the case against feedback is not as straightforward as Norris et al. present it. We use feedback consistency effects to illustrate these points.

Readers of TopiCS are invited to join a debate about the utility of ideas and methods of complexity science. The topics of debate include empirical instances of qualitative change in cognitive activity and whether this empirical work demonstrates sufficiently the empirical flags of complexity. In addition, new phenomena discovered by complexity scientists, and motivated by complexity theory, call into question some basic assumptions of conventional cognitive science such as stable equilibria and homogeneous variance. The articles and commentaries that appear in (...) this issue also illustrate a new debate style format for topiCS. (shrink)

How do people decide what to say in context? Many theories of pragmatics assume that people have specialized knowledge that drives them to utter certain words in different situations. But these theories are mostly unable to explain both the regularity and variability in people’s speech behaviors. Our purpose in this article is to advance a view of pragmatics based on complexity theory, which specifically explains the pragmatic choices speakers make in conversations. The concept of self-organized criticality sheds light on how (...) a history of utterances and subtle details of a situation surrounding a conversation may directly specify language behavior. Under this view, pragmatic choice in discourse does not reflect the output of any dedicated pragmatic module but arises from a complex coordination or coupling between speakers and their varying communicative tasks. (shrink)

Observations of ultrafast cognition in human performance challenge intuitive information processing and computation metaphors of cognitive processing. Instances of ultrafast cognition are marked by ultrafast response times of reliable, accurate responses to a relatively complex stimulus. Ultrafast means response times that are as fast as a single feedforward burst of activity across the nervous system connecting eye to hand. Thus the information processing and computation metaphors in question are those in which some amount of time is required to decide and (...) initiate a response, over and above the minimum time required, physiologically, for the eye-hand chain of action potentials—these are metaphors in which the brain does work that has a measurable duration in time. Ultrafast cognition can be explained by synergies spanning the mind and body. Synergies are temporary dynamical structures that anticipate context-appropriate behaviour. An anticipatory state poises the mind and body in symmetry among equivalent options for behaviour, and only a minimal change in context, favouring one option over any other, is sufficient to break symmetry and enact an ultrafast cognitive response. (shrink)

The commentators expressed concerns regarding the relevance and value of non-computational non-symbolic explanations of cognitive performance. But what counts as an “explanation” depends on the pre-theoretical assumptions behind the scenes of empirical science regarding the kinds of variables and relationships that are sought out in the first place, and some of the present disagreements stem from incommensurate assumptions. Traditional cognitive science presumes cognition to be a decomposable system of components interacting according to computational rules to generate cognitive performances (i.e., component-dominant (...) dynamics). We assign primacy to interaction-dominant dynamics among components. Though either choice can be a good guess before the fact, the primacy of interactions is now supported by much recent empirical work in cognitive science. Consequently, in the main, the commentators have failed so far to address the growing evidence corroborating the theory-driven predictions of complexity science. (shrink)

Borrett, Kelly and Kwan [ Phenomenology, dynamical neural networks and brain function, Philosophical Psychology, 13, 000-000] claim that unbiased, self-evident, direct description is possible, and may supply the data that brain theories account for. Merleau-Ponty's [ Phenomenology of perception, London: Routledge] description of Schneider's apraxia is offered as a case in point. According to the authors, Schneider's apraxia justifies brain components of predicative and pre-predicative experience. The description derives from a bias, however, that parallels modularity's morphological reduction. The presence of (...) biasing presuppositions contradicts the goal of direct description. Moreover, the authors' brain account is not necessary to explain Schneider's apraxia, and morphological reduction is not sufficient to explain emergent phenomena of motor control. (shrink)

The suggestion of seeking specificity in a higher-order array is attractive, but Stoffregen & Bardy fail to provide a compelling empirical basis to their claim that specificity exists solely in the global array. Using the example of relative motion, the alternate hypotheses that must be considered are presented.

Human neural and behavioral activities have been reported to exhibit fractal dynamics known as 1/f noise, which is more aptly named 1/f scaling. Some argue that 1/f scaling is a general and pervasive property of the dynamical substrate from which cognitive functions are formed. Others argue that it is an idiosyncratic property of domain‐specific processes. An experiment was conducted to investigate whether 1/f scaling pervades the intrinsic fluctuations of a spoken word. Ten participants each repeated the word bucket over 1,000 (...) times, and fluctuations in acoustic measurements across repetitions generally followed the 1/f scaling relation, including numerous parallel yet distinct series of 1/f fluctuations. On the basis of work showing that 1/f scaling is a universal earmark of metastability, it is proposed that the observed pervasiveness of 1/f fluctuations in speech reflects the fact that cognitive functions are formed as metastable patterns of activity in brain, body, and environment. (shrink)

In some areas of cognitive science we are confronted with ultrafast cognition, exquisite context sensitivity, and scale-free variation in measured cognitive activities. To move forward, we suggest a need to embrace this complexity, equipping cognitive science with tools and concepts used in the study of complex dynamical systems. The science of movement coordination has benefited already from this change, successfully circumventing analogous paradoxes by treating human activities as phenomena of self-organization. Therein, action and cognition are seen to be emergent in (...) ultrafast symmetry breaking across the brain and body; exquisitely constituted of the otherwise trivial details of history, context, and environment; and exhibiting the characteristic scale-free signature of self-organization. (shrink)

Though the central concept in International Relations, not so much importance was yet attached to the operationalisation of national power.In his overview, the author distinguishes three conceptual approaches:1° exercised power ; 2° status ; 3° potential power.An operationalisation of exercised power is not yet available because of grave theoretical and practical difficulties. Indices of status are elaboratedbut the relevance of this concept seems to be low.Potential power, the most intresting approach is aften elaborated; the present-day operationalisations however don't correspond to (...) what the «great theoretici» wrote about «the elements of national power».In most cases only one or a few indicators are included; most operationalisations don't deliver a rank ordening but only a stratification...The author concludes research attention should be attached to the operationalisation of power, especially potential power. (shrink)

An unresolved issue in the occupational health literature that is of both theoretical and practical importance is whether interpersonal conflicts, aggression and bullying at work are distinct or overlapping phenomena for exposed workers. In this study, we addressed this question empirically by employing a Latent Class (LC) analysis using cross-industry data from 6,175 Belgian workers. We found that a two-factor solution with a conflict-aggression factor and a bullying factor had the best fit. Employees with low exposure to workplace conflicts-aggression and (...) bullying perceived the phenomena as mostly overlapping. Reversely, employees who were exposed more frequently to the phenomena perceived them as more distinct - especially so for workplace bullying. Conflicts-aggression and bullying seem to be perceived as separate phenomena given their distinctive relationships with criterion variables in the domain of well-being and strain. These findings entail that a simple unifying approach or a single label for the three phenomena is not appropriate, at least from a measurement point of view and from the different perspectives of those exposed. Our results have important implications for the theoretical understanding of the concepts of interpersonal conflicts, aggression and bullying, and for practitioners who have to assist those involved with how to handle these problems and who have to develop legal as well as internal policies for the prevention and management of these issues at the workplace. (shrink)

We present a set-theoretic model of the mental representation of classically quantified sentences (All P are Q, Some P are Q, Some P are not Q, and No P are Q). We take inclusion, exclusion, and their negations to be primitive concepts. We show that although these sentences are known to have a diagrammatic expres- sion (in the form of the Gergonne circles) that constitutes a semantic representation, these concepts can also be expressed syntactically in the form of algebraic formulas. (...) We hypothesized that the quantified sen- tences have an abstract underlying representation common to the formulas and their associated sets of dia- grams (models). We derived 9 predictions (3 semantic, 2 pragmatic, and 4 mixed) regarding people’s as- sessment of how well each of the 5 diagrams expresses the meaning of each of the quantified sentences. We report the results from 3 experiments using Gergonne’s (1817) circles or an adaptation of Leibniz (1903/ 1988) lines as external representations and show them to support the predictions. (shrink)

We present a set-theoretic model of the mental representation of classically quantified sentences (All P are Q, Some P are Q, Some P are not Q, and No P are Q). We take inclusion, exclusion, and their negations to be primitive concepts. It is shown that, although these sentences are known to have a diagrammatic expression (in the form of the Gergonne circles) which constitute a semantic representation, these concepts can also be expressed syntactically in the form of algebraic formulas. (...) It is hypothesized that the quantified sentences have an abstract underlying representation common to the formulas and their associated sets of diagrams (models). Nine predictions are derived (three semantic, two pragmatic, and four mixed) regarding people's assessment of how well each of the five diagrams expresses the meaning of each of the quantified sentences. The results from three experiments, using Gergonne's circles or an adaptation of Leibniz lines as external representations, are reported and shown to support the predictions. (shrink)

Brain damage may doubly dissociate cognitive modules, but the practice of revealing dissociations is predicated on modularity being true (T. Shallice, 1988). This article questions the utility of assuming modularity, as it examines a paradigmatic double dissociation of reading modules. Reading modules illustrate two general problems. First, modularity fails to converge on a fixed set of exclusionary criteria that define pure cases. As a consequence, competing modular theories force perennial quests for purer cases, which simply perpetuates growth in the list (...) of exclusionary criteria. The first problem leads, in part, to the second problem. Modularity fails to converge on a fixed set of pure cases. The second failure perpetuates unending fractionation into more modules. (shrink)

The method of positron emission tomography illustrates the circular logic popular in subtractive neuroimaging and linear reductive cognitive psychology. Both require that strictly feed-forward, modular, cognitive components exist, before the fact, to justify the inference of particular components from images after the fact. Also, both require a "true" componential theory of cognition and laboratory tasks, before the fact, to guarantee reliable choices for subtractive contrasts. None of these possibilities are likely. Consequently, linear reductive analysis has failed to yield general, reliable, (...) componential accounts. (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)

Among the hundreds of sites that housed survivors of Nazi persecution who came to Sweden in the spring and summer of 1945, one of the largest was at the small village of Öreryd. Between June 1945 and September 1946, around a thousand Jewish and non-Jewish Polish survivors came to this site, where they were expected to stay only until they were well enough to return to their home countries or migrate elsewhere. This article contributes to filling a gap in refugee (...) history in Sweden, dealing with how survivors experienced Swedish refugee camps and shaped the refugee camp environment on their own terms. Thinking with Peter Gatrell’s framework of ‘refugeedom’, a wide range of sources have been examined for insight into how Polish survivors in the Öreryd refugee camp navigated the precarity and uncertainty of their existence as survivors and refugees in Sweden and endeavoured to shape their immediate and future lives. (shrink)

This paper discusses the debate over whether emotional expressions are spontaneous or intentional actions. We describe a variety of empirical evidence supporting these two possibilities. But we argue that the spontaneous-intentional distinction fails to explain the psychological dynamics of emotional expressions. We claim that a complex systems perspective on intentions, as self-organized critical states, may yield a unified view of emotional expressions as a consequence of situated action. This account simultaneously acknowledges the embodied status of environment, evolution, culture and mind (...) in theories of emotion. (shrink)

In recent years, facial difference is increasingly on the public and academic agenda. This is evidenced by the growing public presence of individuals with an atypical face, and the simultaneous emergence of research investigating the issues associated with facial variance. The scholarship on facial difference approaches this topic either through a medical and rehabilitation perspective, or a psycho-social one. However, having a different face also encompasses an embodied dimension. In this paper, we explore this embodied dimension by interpreting the stories (...) of individuals with facial limb absence against the background of phenomenological theories of the body, illness and disability. Our findings suggest that the atypical face disrupts these individuals’ engagement with everyday projects when it gives rise to disruptive perceptions, sensations, and observations. The face then ceases to be the absent background to perception, and becomes foregrounded in awareness. The disruptions evoked by facial difference call for adjustments: as they come to terms with their altered face, the participants in our study gradually develop various new bodily habits that re-establish their face’s absence, or relate to its disruptive presence. It is through these emergent habits that facial difference comes to be embodied. By analyzing the everyday experiences of individuals with facial limb absence, this article provides a much-needed exploration of the embodied aspects of facial difference. It also exemplifies how a phenomenological account of illness and disability can do justice both to the impairments and appearance issues associated with atypical embodiment. (shrink)

BackgroundSexual boundary violations in healthcare are harmful and exploitative sexual transgressions in the professional–client relationship. Persons with mental health issues or intellectual disabilities, especially those living in residential settings, are especially vulnerable to SBV because they often receive long-term intimate care. Promoting good sexual health and preventing SBV in these care contexts is a moral and practical challenge for healthcare organizations.MethodsWe carried out a qualitative interview study with 16 Dutch policy advisors, regulators, healthcare professionals and other relevant experts to explore (...) their perspectives on preventing SBV in mental health and disability care organizations. We used inductive thematic analysis to interpret our data.ResultsWe found three main themes on how healthcare organizations can prevent SBV in mental health and disability care: setting rules and regulations, engaging in dialogue about sexuality, and addressing systemic and organizational dimensions.ConclusionOur findings suggest that preventing SBV in mental health and disability care organizations necessitates setting suitable rules and regulations and facilitating dialogue about positive aspects of sexuality and intimacy, as well as about boundaries, and inappropriate behaviors or feelings. Combining both further requires organizational policies and practices that promote transparency and reflection, and focus on creating a safe environment. Our findings will help prevent SBV and promote sexual health in mental health and disability care organizations. (shrink)

Moral Constraints on War offers a principle-by-principle presentation of the transcultural roots of the ethics of war in an age defined by the increasingly international nature of military intervention.

Brain damage may doubly dissociate cognitive modules, but the practice of revealing dissociations is predicated on modularity being true (T. Shallice, 1988). This article questions the utility of assuming modularity, as it examines a paradigmatic double dissociation of reading modules. Reading modules illustrate two general problems. First, modularity fails to converge on a fixed set of exclusionary criteria that define pure cases. As a consequence, competing modular theories force perennial quests for purer cases, which simply perpetuates growth in the list (...) of exclusionary criteria. The first problem leads, in part, to the second problem. Modularity fails to converge on a fixed set of pure cases. The second failure perpetuates unending fractionation into more modules. (shrink)

The method of positron emission tomography (PET imaging) illustrates the circular logic popular in subtractive neuroimaging and linear reductive cognitive psychology. Both require that strictly feed-forward, modular, cognitive components exist, before the fact, to justify the inference of particular components from images (or other observables) after the fact. Also, both require a "true" componential theory of cognition and laboratory tasks, before the fact, to guarantee reliable choices for subtractive contrasts. None of these possibilities are likely. Consequently, linear reductive analysis has (...) failed to yield general, reliable, componential accounts. (shrink)

BackgroundIn the Netherlands, patients have the legal right to make a request for euthanasia to their physician. However, it is not clear what it means in a moral sense for a physician to receive a request for euthanasia. The aim of this study is to explore the moral values of physicians regarding requests for euthanasia. MethodsSemi-structured interviews were conducted with nine primary healthcare physicians involved in decision-making about euthanasia. The data were inductively analyzed which lead to the emergence of themes, (...) one of which was about values regarding end-of-life decisions.ResultsFour clusters of values related to euthanasia requests are described: values related to 1) the patient; 2) the family; 3) the physician; and 4) life and death. The data show that the participants value patient autonomy as a necessary but not sufficient condition for meeting a euthanasia request. A good relationship with the patient and the family are important. For the physician, the values physician autonomy, responsibility, understanding the patient and relief of suffering play a role. Life as an intrinsic good and a peaceful death are also important values.ConclusionThis study shows that next to patient autonomy and the relationship with the patient and the family, it is important for the participants to act in accordance with their professional values and to do justice to values related to life and death. The awareness of going against the intrinsic value of life is crucial, even if performing euthanasia may result in a feeling of relief or gratitude afterwards. (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)

An important discussion in contemporary ethics concerns the relevance of empirical research for ethics. Specifically, two crucial questions pertain, respectively, to the possibility of inferring normative statements from descriptive statements, and to the danger of a loss of normativity if normative statements should be based on empirical research. Here we take part in the debate and defend integrated empirical ethical research: research in which normative guidelines are established on the basis of empirical research and in which the guidelines are empirically (...) evaluated by focusing on observable consequences. We argue that in our concrete example normative statements are not derived from descriptive statements, but are developed within a process of reflection and dialogue that goes on within a specific praxis. Moreover, we show that the distinction in experience between the desirable and the undesirable precludes relativism. The normative guidelines so developed are both critical and normative: they help in choosing the right action and in evaluating that action. Finally, following Aristotle, we plead for a return to the view that morality and ethics are inherently related to one another, and for an acknowledgment of the fact that moral judgments have their origin in experience which is always related to historical and cultural circumstances. (shrink)

BackgroundExisting clinical ethics support (CES) instruments are considered useful. However, users report obstacles in using them in daily practice. Including end users and other stakeholders in developing CES instruments might help to overcome these limitations. This study describes the development process of a new ethics support instrument called CURA, a low-threshold four-step instrument focused on nurses and nurse assistants working in palliative care. MethodWe used a participatory development design. We worked together with stakeholders in a Community of Practice throughout the (...) study. Potential end users (nurses and nurse assistants in palliative care) used CURA in several pilots and provided us with feedback which we used to improve CURA.ResultsWe distinguished three phases in the development process. Phase one, Identifying Needs, focused on identifying stakeholder and end user needs and preferences, learning from existing CES instruments, their development and evaluation, and identify gaps. Phase two, Development, focused on designing, developing, refining and tailoring the instrument on the basis of iterative co-creation. Phase three, Dissemination, focused on implementation and dissemination. The instrument, CURA, is a four-step low-threshold instrument that fosters ethical reflection.ConclusionsParticipatory development is a valuable approach for developing clinical ethics support instruments. Collaborating with end users and other stakeholders in our development study has helped to meet the needs and preferences of end users, to come up with strategies to refine the instrument in order to enhance its feasibility, and to overcome reported limitations of existing clinical ethics instruments. (shrink)

BackgroundMoral case deliberation as a form of clinical ethics support is usually implemented in health care institutions and educational programs. While there is no previous research on the use of clinical ethics support on the level of health care regulation, employees of regulatory bodies are regularly confronted with moral challenges. This pilot study describes and evaluates the use of MCD at the Dutch Health Care Inspectorate.The objective of this pilot study is to investigate: 1) the current way of dealing with (...) moral issues at the IGZ; 2) experience with and evaluation of MCD as clinical ethics support, and 3) future preferences and needs regarding clinical ethics support for dealing with moral questions at the IGZ.MethodsWe performed an explorative pilot study. The research questions were assessed by means of: 1) interviews with MCD participants during four focus groups; and 2) interviews with six key stakeholders at the IGZ. De qualitative data is illustrated by data from questionnaires on MCD outcomes, perspective taking and MCD evaluation.ResultsProfessionals do not always recognize moral issues. Employees report a need for regular and structured moral support in health care regulation. The MCD meetings are evaluated positively. The most important outcomes of MCD are feeling secure and learning from others. Additional support is needed to successfully implement MCD at the Inspectorate.ConclusionWe conclude that the respondents perceive moral case deliberation as a useful form of clinical ethics support for dealing with moral questions and issues in health care regulation. (shrink)

This article presents an ethics support instrument for healthcare professionals called CURA. It is designed with a focus on and together with nurses and nurse assistants in palliative care. First, we shortly go into the background and the development study of the instrument. Next, we describe the four steps CURA prescribes for ethical reflection: (1) Concentrate, (2) Unrush, (3) Reflect, and (4) Act. In order to demonstrate how CURA can structure a moral reflection among caregivers, we discuss how a case (...) was discussed with CURA at a psychogeriatric ward of an elderly care home. Furthermore, we go into some considerations regarding the use of the instrument in clinical practice. Finally, we focus on the need for further research on the effectiveness and implementation of CURA. (shrink)

The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation. First, we will analyse the guideline's main premise, which entails that palliative sedation is normal medical treatment. After this, we will critically discuss three crucial propositions of (...) the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline. (shrink)

This article examines how people with type 2 diabetes perceive autonomous decision making and which moral capacities they consider important in diabetes nurses' support of autonomous decision making. Fifteen older adults with type 2 diabetes were interviewed in a nurse-led unit. First, the data were analysed using the grounded theory method. The participants described a variety of decision-making processes in the nurse and family care-giver context. Later, descriptions of the decision-making processes were analysed using hermeneutic text interpretation. We suggest first- (...) and second-order moral capacities that nurses specializing in diabetes need to promote the autonomous decision making of their patients. We recommend nurses to engage in ongoing, interactive reflective practice to further develop these moral capacities. (shrink)

Evaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with five-point Likert scales (...) were used. The feasibility questionnaire was given to all respondents, the perceived outcomes questionnaire only to the course participants. Data collection took place over a period of six months. Respondents were predominantly positive on most items of the feasibility questionnaire. The steps of CURA are clearly described (84% of course participants agreed or strongly agreed, 94% of colleagues) and easy to apply (78–87%). The perceived outcomes showed that CURA helped respondents to reflect on moral challenges (71% (strongly) agreed), in perspective taking (67%), with being aware of moral challenges (63%) and in dealing with moral distress (54%). Respondents did experience organizational barriers: only half of the respondents (strongly) agreed that they could easily find time for using CURA. CURA is a feasible instrument for nurses and nurse assistants providing palliative care. However, reported difficulties in organizing and making time for reflections with CURA indicate organizational preconditions ought to be met in order to implement CURA in daily practice. Furthermore, these results indicate that CURA helps to build moral competences and fosters moral resilience. (shrink)

Evaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with five-point Likert scales (...) were used. The feasibility questionnaire was given to all respondents, the perceived outcomes questionnaire only to the course participants. Data collection took place over a period of six months. Respondents were predominantly positive on most items of the feasibility questionnaire. The steps of CURA are clearly described (84% of course participants agreed or strongly agreed, 94% of colleagues) and easy to apply (78–87%). The perceived outcomes showed that CURA helped respondents to reflect on moral challenges (71% (strongly) agreed), in perspective taking (67%), with being aware of moral challenges (63%) and in dealing with moral distress (54%). Respondents did experience organizational barriers: only half of the respondents (strongly) agreed that they could easily find time for using CURA. CURA is a feasible instrument for nurses and nurse assistants providing palliative care. However, reported difficulties in organizing and making time for reflections with CURA indicate organizational preconditions ought to be met in order to implement CURA in daily practice. Furthermore, these results indicate that CURA helps to build moral competences and fosters moral resilience. (shrink)