Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in long-term (...) care of patients in VS/UWS. A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making. (shrink)

_ Source: _Volume 40, Issue 1, pp 104 - 115 It is intended in this study to present initial reliability and validity data for the Russian adaptation of the Multidimensional Inventory of Religious/Spiritual Well-being, as being related to personality factors and psychopathology. Therefore, the first version of the MI-RSWB-R was applied to a sample of 192 non-clinical subjects, together with the NEO Five Factor Inventory and the Symptom-Check-List. The original six-factor structure of the scale could be replicated for the MI-RSWB-R, (...) which also provides satisfying psychometric properties. In accordance with previous research the RSWB total score was linked to more favorable personality traits such as Extraversion, Openness to Experience, and Agreeableness, which was paralleled by substantial negative correlations with increased psychopathology. Our findings support the reliability and structural validity of the MI-RSWB-R as a standardized instrument for addressing the spiritual dimension in Russian populations. Further research in clinical surroundings is now recommended. (shrink)

Objectives: To study the consent process experienced by participants who are enrolled in a molecular genetic research study that aims to find new genetic mutations responsible for an apparently inherited disorder.Design: Semi-structured interviews and analysis/description of main themes.Participants: 78 members of 52 families who had been recruited to a molecular genetic study.Results: People were well informed about the goals, risks and benefits of the genetic research study but could not remember the consent process. They had mostly been recruited to take (...) part by trusted clinicians or their relatives but had little memory of, or concern about signing consent forms. Families appeared to regard the research as a continuation of their, or their relatives’, clinical care.Conclusions: Ethical review should be more flexible in its attitude to consent forms and written information sheets for some sorts of research. For rare genetic disease studies where research has been discussed fully within the clinical setting then the consent obtained at that time could suffice rather than needing extra consent at a later stage. However, clinician-researchers will need to ensure that their duty of care extends for the duration of the research and beyond. (shrink)

If a hereditary predisposition to colorectal cancer or breast cancer is diagnosed, most guidelines state that clinical geneticists should request index patients to inform their at-risk relatives about the existence of this condition in their family, thus enabling them to consider presymptomatic genetic testing. Those identified as mutation carriers can undertake strategies to reduce their risk of developing the disease or to facilitate early diagnosis. This procedure of informing relatives through the index patient has been criticised, as it results in (...) relatively few requests for genetic testing, conceivably because a certain number of relatives remain uninformed. This pilot study explored attitudes toward informing family members and relevant practices among clinical geneticists. In general, clinical geneticists consider it to be in the interests of family members to be informed and acknowledge that this goal is not accomplished by current procedures. The reasons given for maintaining present practices despite this include clinical ‘mores’, uncertainty about the legal right of doctors to inform family members themselves, and, importantly, a lack of resources. We discuss these reasons from an ethical point of view and conclude that they are partly uninformed and inconsistent. If informing relatives is considered to be in their best interests, clinical geneticists should consider informing relatives themselves. In the common situation in which index patients do not object to informing relatives, no legal obstacles prevent geneticists from doing so. An evaluation of these findings among professionals may lead to a more active approach in clinical practice. (shrink)

In recent times, daily, ordinary medical practices have incontrovertibly been developing under the condition of complexity. Complexity jeopardizes the moral core of practicing medicine: helping people, with their illnesses and suffering, in a medically competent way. Practical wisdom has been proposed as part of the solution to navigate complexity, aiming at the provision of morally good care. Practical wisdom should help practitioners to maneuver in complexity, where the presupposed linear ways of operating prove to be insufficient. However, this solution is (...) unsatisfactory, because the proposed versions of practical wisdom are too individualistic of nature, while physicians are continuously operating in varying teams, and dealing with complicated technologies and pressing structures. A second point of critique is, that these versions are theory based, and thus insufficiently attuned to the actual context of everyday medical practices. Now, our proposal is to use an approach of practical wisdom that enables medical practices to counter the complexity issue and to re-invent the moral core of medical practicing as well. This implies a practice oriented approach, as thematized by practice theory, qualitative empirical research from the inside, and abduction from actual performed practical wisdom towards an apt understanding of phronèsis. (shrink)

Scientific and technological improvements are accomplished only because of much research. The increase in the number of research studies causes a rise in ethical problems. Nursing research is no exception to this. The aim of this study is to identify and analyse ethical problems in nursing studies. This research is descriptive and partly analytical. It is retrospective in the sense that 169 Master of Science and 66 doctoral theses written between 1972 and 1998 in the Department of Nursing, Institute of (...) Health Sciences, Hacettepe University, Ankara, Turkey, were examined. The following ethical rules were used as criteria: that no harm should be caused to the subject; the subject was informed about the research topic; permission was obtained from the subject; and the privacy of the subject was maintained. The evaluation was carried out by distributing the theses among background variables and by employing nonparametric tests. The research associated with the theses was not harmful to the participants in 93.2%, while 6.8% were considered to have caused harm. In 72.7% of the theses the subjects were not informed of the research; in 73.6%, the researchers did not obtain permission from the subjects; and in 8.5% their privacy was not kept. An ethical score was assigned to each thesis, which varyed between 0 and 15. The mean score was 5.02. (shrink)

Considering Pragma-Dialectics honors the monumental contributions of one of the foremost international figures in current argumentation scholarship: Frans van Eemeren. The volume presents the research efforts of his colleagues and addresses how their work relates to the pragma-dialectical theory of argumentation with which van Eemeren’s name is so intimately connected. This tribute serves to highlight the varied approaches to the study of argumentation and is destined to inspire researchers to advance scholarship in the field far into the future. Replete with (...) contributions from highly-esteemed academics in argumentation study, chapters in this volume address such topics as: *Pragma-dialectic versus epistemic theories of arguing and arguments; *Pragma-dialectics and self-advocacy in physician-patient interactions; *The pragma-dialectical analysis of the ad hominem family; *Rhetoric, dialectic, and the functions of argument; and *The semantics of reasonableness. As an exceptional volume and a fitting tribute, this work will be of interest to all argumentation scholars considering the astute insights and scholarly legacy of Frans van Eemeren. (shrink)

Considering Pragma-Dialectics honors the monumental contributions of one of the foremost international figures in current argumentation scholarship: Frans van Eemeren. The volume presents the research efforts of his colleagues and addresses how their work relates to the pragma-dialectical theory of argumentation with which van Eemeren’s name is so intimately connected. This tribute serves to highlight the varied approaches to the study of argumentation and is destined to inspire researchers to advance scholarship in the field far into the future. Replete with (...) contributions from highly-esteemed academics in argumentation study, chapters in this volume address such topics as: *Pragma-dialectic versus epistemic theories of arguing and arguments; *Pragma-dialectics and self-advocacy in physician-patient interactions; *The pragma-dialectical analysis of the ad hominem family; *Rhetoric, dialectic, and the functions of argument; and *The semantics of reasonableness. As an exceptional volume and a fitting tribute, this work will be of interest to all argumentation scholars considering the astute insights and scholarly legacy of Frans van Eemeren. (shrink)

For the successful achievement of evidence-based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a re-clarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to review outcome measures for (...) use in routine care settings. Central features include the user-centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence-based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care. (shrink)

The “Tower of London” puzzle was adapted to tablet PCs to be used as a clinical bedside test. “Iso-problems”, a specific class of problems, require identical moves but ball colours are permuted. Thus difficulty is the same even if the appearance is different. We wanted to determine the impact of these as yet little-studied tasks and hypothesised that there may be a learning effect specific to them (the “iso-effect”). We interspersed a set of six iso-problems within one selection of 22 (...) tasks and analysed problem solving by 81 healthy adults (mean age 41.6 years). Participants showed learning across iso-problems (less time, fewer moves, increasingly efficient solutions). This effect was distinct from general learning, as was obvious from comparison with a series of non-isomorphic tasks. However, participants seem not to be aware of solving such problems. This “iso-effect” may be related to implicit memory, a domain that so far has not been assessed using the Tower of London. (shrink)

We present the idea of searching for X-rays as a signature of the mechanism inducing the spontaneous collapse of the wave function. Such a signal is predicted by the continuous spontaneous localization theories, which are solving the “measurement problem” by modifying the Schrödinger equation. We will show some encouraging preliminary results and discuss future plans and strategy.

Little is known about the background of atheism in Malaysia and how Muslims respond to the phenomenon, although provocations by Malaysian atheists often take place on social media. This study addressed the gap by exploring the atheism phenomenon in Malaysia’s ethnoreligious-oriented society. Data were collected from in-depth interviews and content analysis using the qualitative method. All data were analysed thematically using the software for qualitative analysis, ATLAS.ti. The resulting superordinate themes that emerged from the analysis include the phenomenon of Malaysian (...) atheism, the factors for becoming atheists and the theme of arguments. The study’s findings are three-fold. Firstly, atheism started in Malaysia after globalisation began. Secondly, most Malaysian atheists were influenced by internal factors based on emotional–psychological elements rather than being scientifically oriented. Last but not least, the main themes of Malaysian atheist arguments are ‘God’s justice’, ‘the problem of evil’ and ‘science rationalism’. As a response, Muslims counter the atheism phenomenon by providing an effective approach to preserving social cohesion and harmony in an ethnoreligious society.Contribution: This article suggests that although atheism is regarded as a challenge to society since Malaysia is an ethnoreligious-oriented society, atheism needs to be countered through proper education as early prevention, besides encouraging healthy discussions. (shrink)

Recently, a class of $\mathcal{P}\mathcal{T}$ -invariant scalar quantum field theories described by the non-Hermitian Lagrangian $\mathcal{L}$ = $ \frac{1}{2} $ (∂ϕ) 2 +gϕ 2 (iϕ)ε was studied. It was found that there are two regions of ε. For ε<0 the $\mathcal{P}\mathcal{T}$ -invariance of the Lagrangian is spontaneously broken, and as a consequence, all but the lowest-lying energy levels are complex. For ε≥0 the $\mathcal{P}\mathcal{T}$ -invariance of the Lagrangian is unbroken, and the entire energy spectrum is real and positive. The subtle (...) transition at ε=0 is not well understood. In this paper we initiate an investigation of this transition by carrying out a detailed numerical study of the effective potential V eff (ϕc) in zero-dimensional spacetime. Although this numerical work reveals some differences between the ε<0 and the ε>0 regimes, we cannot yet see convincing evidence of the transition at ε=0 in the structure of the effective potential for $\mathcal{P}\mathcal{T}$ -symmetric quantum field theories. (shrink)

Interactive technology assessment (iTA) provides an answer to the ethical problem of normative bias in evaluation research. This normative bias develops when relevant perspectives on the evaluand (the thing being evaluated) are neglected. In iTA this bias is overcome by incorporating different perspectives into the assessment. As a consequence, justification of decisions based on the assessment is provided by stakeholders having achieved agreement. In this article, agreement is identified with wide reflective equilibrium to show that it indeed has the potential (...) of justifying decisions. We work out several conditions for this agreement to be achievable and just. (shrink)