There is a claim that clinical ethics support services (CESS) improve healthcare quality within healthcare organisations. However, there is lack of strong evidence supporting this claim. Rather, the current focus is on the quality of CESS themselves or on individual learning outcomes. In response, this article proposes a theoretical framework leading to empirical hypotheses that describe the relationship between a specific type of CESS, moral case deliberation and the quality of care at the organisational level. We combine insights from the (...) literature on CESS, organisational learning and quality improvement and argue that moral case deliberation causes healthcare professionals to acquire practical wisdom. At the organisational level, where improving quality is a continuous and collective endeavour, this practical wisdom can be aggregated into morisprudence, which is an ongoing formulation of moral judgements across cases encountered within the organisation. Focusing on the development of morisprudence enables refined scrutinisation of CESS-related quality claims. (shrink)

Hoewel in de laatste jaren sterk de nadruk is gelegd op de “autonomie” van het geschrevene ten opzichte van de schrijver en diens belevingswereld, wil deze auteur graag beginnen met een persoonlijke betuiging van erkentelijkheid. Een mens is toch wel zodanig verbonden met een geesteskind dat hij lang bij zich gedragen heeft, dat hij de aandacht en de grondigheid die uit de hiervoor geplaatste reacties spreekt, alleen maar in hoge mate kan waarderen. Hij heeft ze ervaren als toonbeelden van “ontmoeting”. (...) De verschillen tussen de drie reacties laten nog eens zien dat ontmoeting verre van monotoon is. Juist ook die verschillen vond ik leerzaam. Bij de opzet van mijn repliek wil ik aan de diversiteit zo goed mogelijk recht doen door de reacties stuk voor stuk te bespreken. Af en toe zal een “intertekstuele” opmerking wenselijk of onvermijdelijk zijn. Overigens vrees ik dat binnen het bestek van deze repliek niet voldoende ingegaan kan worden op alle vragen en tegenwerpingen. (shrink)

Bijdragen over de actuele betekenis van de filosofie, met name de Reformatorische Wijsbegeerte.

Approximately three decades ago the question was first answered whether parasitoids are able to assess the number or origin of eggs in a host for a solitary parasitoid, Leptopilina heterotoma, by fitting theoretically derived distributions to empirical ones. We extend the set of different theoretically postulated distributions of eggs among hosts by combining searching modes and abilities in assessing host quality. In the models, parasitoids search either randomly (Poisson) (1) or by vibrotaxis (Negative Binomial) (2). Parasitoids are: (a) assumed to (...) treat all hosts equally, (b) able to distinguish them in unparasitised and parasitised hosts only, (c) able to distinguish them by the number of eggs they contained, or (d) able to recognise their own eggs. Mathematically tractable combinations of searching mode (1 and 2) and abilities (a,b,c,d) result in seven different models (M1a, M1b, M1c, M1d, M2a, M2b and M2c). These models have been simulated for a varying number of searching parasitoids and various mean numbers of eggs per host. Each resulting distribution is fitted to all theoretical models. The model with the minimum Akaike's information criterion (AIC) is chosen as the best fitting for each simulated distribution. We thus investigate the power of the AIC and for each distribution with a specified mean number of eggs per host we derive a frequency distribution for classification.Firstly, we discuss the simulations of models including random search (M1a, M1b, M1c and M1d). For M1a, M1c and M1d the simulated distributions are correctly classified in at least 70% of all cases. However, in a few cases model M1b is only properly classified for intermediate mean values of eggs per host. The models including vibrotaxis as searching behaviour (M2a, M2b and M2c) cannot be distinguished from those with random search if the mean number of eggs per host is low. Among the models incorporating vibrotaxis the three abilities are detected analogously as in models with random search. (shrink)

ABSTRACT Match-fixing is a major ethical issue in sports. Although research interest in match-fixing has increased in recent years, we remain largely in the dark regarding how both betting- and non-betting-related match-fixing relate to the moral decision-making of those involved. Drawing on Rest’s theory of morality and on the perceptions of a large sample of participants in Flemish sports, this study indicates that most match-fixing incidents are non-betting-related, while moral motivation and associated challenges clearly differ according to the type of (...) match-fixing. Therefore, each type of match-fixing requires different preventive measures. (shrink)

Dit artikel is, samen met een nog volgend tweede, bedoeld als aanzet tot een bredere studie. Die studie zal, naar ik hoop, binnen twee jaar voltooid zijn. Ze maakt in zekere mate deel uit van een onderzoeksprogramma dat in uitvoering is aan de Faculteit der Wijsbegeerte van de Vrije Universiteit. Het is nu niet van belang de eigen plaats ervan binnen dat programma nauwkeuriger te omschrijven. Wel kan worden gezegd dat de studie een sterk historische inslag heeft, maar uitmondt in (...) een meer persoonlijke, systematische beschouwing. Dat artikelen met dit thema een plaats krijgen in Philosophia Reformata, behoeft waarschijnlijk weinig betoog. Een tijdschrift dat ontstaan is uit een herbezinning op reikwijdte en functie van “rede”, een herbezinning die ertoe leidde “liefde” als dieptemotief in de werkelijkheid te honoreren, —zo’n tijdschrift lijkt geen ongeschikte plek. (shrink)

Diverse omstandigheden hebben het schrijven en verschijnen van het in jaargang 62, nr. 2 aangekondigde slotartikel vertraagd. Ook toen al uitte ik het voornemen de vier denkers die in het tweede artikel besproken waren nog even te groeperen. Zo’n korte groepering lijkt nu, na meer dan twee jaar, des te meer wenselijk. De vier besproken filosofen waren allen, zij het op uiteenlopende wijze, op zoek naar een nieuwe bepaling van de verhoudingen, — niet alleen tussen “Leidenschaft” en “Vernunft”, maar ook (...) tussen “Leidenschaft” als in-zet — meer actief — en als “passio”, in de zin van “lijden”. (shrink)

A review is given on statistical and modelling issues in ecotoxicology. The issues discussed are:1. How to estimate an (almost) no effect concentration chemicals in the laboratory.

The differential field of transseries extends the field of real Laurent series and occurs in various contexts: asymptotic expansions, analytic vector fields, and o-minimal structures, to name a few. We give an overview of the algebraic and model-theoretic aspects of this differential field and report on our efforts to understand its elementary theory.

In the Netherlands, in 1995 approximately 9700 people explicitly requested euthanasia or assisted suicide, and EAS was performed approximately 3600 times. The most important reasons for not performing EAS when requested by a patient were that the patient died before EAS was performed, or that the physician refused the request.

Objective—Consultation of another physician is an important method of review of the practice of euthanasia. For the project “support and consultation in euthanasia in Amsterdam” which is aimed at professionalising consultation, a protocol for consultation was developed to support the general practitioners who were going to work as consultants and to ensure uniformity. Participants—Ten experts (including general practitioners who were experienced in euthanasia and consultation, a psychiatrist, a social geriatrician, a professor in health law and a public prosecutor) and the (...) general practitioners who were going to use the protocol. Evidence—There is limited literature on consultation: discursive articles and empirical studies describing the practice of euthanasia. Consensus—An initial draft on the basis of the literature was commented on by the experts and general practitioners in two rounds. Finally, the protocol was amended after it had been used during the training of consultants. Conclusions—The protocol differentiates between steps that are necessary in a consultation and steps that are recommended. Guidelines about four important aspects of consultation were given: independence, expertise, tasks and judgment of the consultant. In 97% of 109 consultations in which the protocol was used the consultant considered the protocol to be useful to a greater or lesser extent. Although this protocol was developed locally, it also employs universal principles. Therefore it can be of use in the development of consultation elsewhere. (shrink)