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 results of an empirical study into the perceptions of “hands-on” experts concerning the welfare of (non-human) animals in traveling circuses in the Netherlands are presented. A qualitative approach, based on in-depth conversations with trainers/performers, former trainers/performers, veterinarians, and an owner of an animal shelter, conveyed several patterns in the contextual construction of perceptions and the use of dissonance reduction strategies. Perceptions were analyzed with the help of the Symbolic Convergence Theory and the model of the frame of reference, consisting (...) of knowledge, convictions, values, norms, and interests. The study shows that the debate regarding animals in circuses in the Netherlands is centered on the level of welfare that is required; the importance of animal welfare is not disputed. Arguments that were used differed according to the respondents’ specific backgrounds and can be placed on a gradient ranging from the conviction that the welfare of animals in circuses is sufficiently warranted and both human and animal enjoy the performance (right end), to the conviction that animal welfare in circuses is negative, combined with the idea that the goal of entertaining people does not outweigh that (left end). The study confirms that perceptions reflect people’s contexts, though the variety in scopes suggests that the (inter)relations between people and their context are complex in nature. Evidence of cognitive dissonance was abundant. Coping strategies were found to be used more by respondents towards the right end of the gradient, suggesting that those respondents experience more ambivalence. This encountered pattern of association between position on the gradient and frequency of dissonance reduction strategies calls for further research on the type of ambivalent feelings experienced. The authors argue that, to come to an agreement about the welfare of animals in circuses, including the way this welfare should be guaranteed, stakeholders from different contexts need to engage in a dialogue in which a distance is taken from right/wrong-schemes and that starts from acceptance of dilemmas and ambiguity. (shrink)

The results of an empirical study into the perceptions of “hands-on” experts concerning the welfare of (non-human) animals in traveling circuses in the Netherlands are presented. A qualitative approach, based on in-depth conversations with trainers/performers, former trainers/performers, veterinarians, and an owner of an animal shelter, conveyed several patterns in the contextual construction of perceptions and the use of dissonance reduction strategies. Perceptions were analyzed with the help of the Symbolic Convergence Theory and the model of the frame of reference, consisting (...) of knowledge, convictions, values, norms, and interests. The study shows that the debate regarding animals in circuses in the Netherlands is centered on the level of welfare that is required; the importance of animal welfare is not disputed. Arguments that were used differed according to the respondents’ specific backgrounds and can be placed on a gradient ranging from the conviction that the welfare of animals in circuses is sufficiently warranted and both human and animal enjoy the performance (right end), to the conviction that animal welfare in circuses is negative, combined with the idea that the goal of entertaining people does not outweigh that (left end). The study confirms that perceptions reflect people’s contexts, though the variety in scopes suggests that the (inter)relations between people and their context are complex in nature. Evidence of cognitive dissonance was abundant. Coping strategies were found to be used more by respondents towards the right end of the gradient, suggesting that those respondents experience more ambivalence. This encountered pattern of association between position on the gradient and frequency of dissonance reduction strategies calls for further research on the type of ambivalent feelings experienced. The authors argue that, to come to an agreement about the welfare of animals in circuses, including the way this welfare should be guaranteed, stakeholders from different contexts need to engage in a dialogue in which a distance is taken from right/wrong-schemes and that starts from acceptance of dilemmas and ambiguity. (shrink)

The case study shows the complex reality with respect to processes of meaning construction. Ruiter’s framework provides a more sophisticated instrument to analyse these complex processes. Unlike the classic models of legal communication, based upon a linear causality between norm and action, and unlike the dual model of interplay between legal institutions and institutional legal facts developed by MacCormick and Weinberger’s Institutional Legal Theory, the tripartite model of interplay between rule, application, and social practices, stemming from Ruiter’s analysis of ILT, (...) can contribute to a more refined model of legal communication. (shrink)

This is a short, dense book in the monograph series published by Bernard Jackson under the Deborah Charles imprint out of Liverpool in the UK. In that setting, the work is part of a tradition that is one of the grand strains of modern semiotics of law. Professor Jackson, first with his own work and then with a series of imprints, has for thirty years provided the semiotics community with much to think about. He has also stood for a particular (...) version of semiotics.The author of the monograph under review, Hanneke van Schooten, is a professor at Tilburg Law School in The Netherlands. She writes on sources of law, and the role of law in international conflict as well as on jurisprudence. She has been an influential contributor to the jurisprudential community that identifies with semiotics as well as law and society.Jurisprudence and Communication has an Introduction, two parts, seven substantive chapters and a Conclusion. As noted above, it is 132 pages long.In the Introduction, van Sch. (shrink)

Zusammenfassung In der sportökonomischen Literatur ist in den vergangenen Jahren eine Hinwendung zum ökonomischen Ansatz unter Verwendung der Modellannahmen des Homo Oeconomicus festzustellen. In diesem Aufsatz wird argumentiert, dass dies Ausdruck des ökonomischen Imperialismus ist, weil unter ökonomischem Imperialismus die Anwendung der ökonomischen Methode auf originär außerwirtschaftliche Lebensbereiche zu verstehen ist. Darüber hinaus wird die Auffassung vertreten, dass diese Anwendung der ökonomischen Methode im Sport in den meisten Fällen zu fruchtbaren Ergebnissen und guten Erklärungen sozialer Situationen im Sport führt. Bei (...) der Anwendung der ökonomischen Methode sind aber die Grenzen und Gefahren hinsichtlich der Rationalität und Motivation der Akteure sowie hinsichtlich des normativen Gehalts der Methode zu berücksichtigen. (shrink)

Phenomenological healthcare research should include the lived experiences of a broad group of healthcare users. In this paper it is shown how shadowing can give a voice to people in vulnerable situations who are often excluded from interview studies. Shadowing is an observational method in which the researcher observes an individual during a relatively long time. Central aspects of the method are the focus on meaning expressed by the whole body, and an extended stay of the researcher in the phenomenal (...) event itself. Inherent in shadowing is a degree of ambivalence that both challenges the researcher and provides meaningful insights about the phenomenon. A case example of a phenomenological study on the experiences of elderly hospital patients is used to show what shadowing yields. (shrink)

This article focuses on the difference between the personal God image and the God image that people perceive as normative, that is to say, the God image they believe they should have according to religious culture. A sample of 544 Dutch respondents, of which 244 received psychotherapy, completed the Dutch Questionnaire of God Images . In general, there appeared to be a discrepancy between the personal and the normative God image. Whether discrepancies were experienced as conflictive was related to religious (...) denomination and mental health. Conflictive feelings were associated with lower religious saliency and higher educational level. Moreover, they were associated with mental health per se and the interaction between mental health and denomination, with patients reporting more conflicts than normals except in the Roman Catholic and Orthodox-Reformed group, where patients and non-patients hardly differed in the experience of conflict. (shrink)

In institutional legal theory, norms and facts are reciprocally operating elements: an interplay in which meaning construction is closely connected with acting: the pragmatic understanding of legal language in terms of its uses. With the semiotic elements of institutional theory, extended by the notion of ‘semiotic groups’, an analytical framework can be constructed to analyze a case study on the shifts in the concept of war which have taken place since the 1945 UN Charter and in the aftermath of 9/11. (...) The semiotic aspects of the institutional approach can offer insight into the complexity of the processes of meaning attribution in the field of law and war. (shrink)

Patient participation in healthcare is highly promoted for democratic reasons. Older patients make up a large part of the hospital population but their voices are less easily heard by most patient participation instruments. The client council can be seen as an important medium to represent the interests of this increasing group of patients. Every Dutch healthcare institution is obliged to have a client council and its rights are legally established. This paper reports on a case study of a client council (...) in a hospital and shows how equality as the core democratic value manifests itself in practice and marginalizes the voices of older patients. Based on the work of Joan Tronto we show that sameness is the driving force behind the functioning of the client council which leads the council to operate as part of the hospital system. Consequently, important aspects of the hospital practice remain out of sight. To be of greater value for all patients we argue that successful patient participation requires not only equal opportunities but also ‘the condition of equal voice’. (shrink)

In general, the relationship between rule and conduct is dominated by the concept of linear causality: the legal rule causes effect in social practice. The case study on Article 96 of the Dutch Constitution and Article 102 of the Dutch Penal Code makes clear that this concept is too simplistic for the complex processes that took place. The clear dividing point between war and peace — i.e., the war declaration that initiates the legal state of war — no longer exists, (...) since a third category —'armed conflicts' — that was 'constituted' in social practice and is positioned 'somewhere' between peace and war. Exact demarcation for this category is problematic. This phenomenon has far-reaching consequences for the meaning of the Articles, mentioned above. (shrink)

A recent line of argumentation research has focused on the examination of prototypical argumentative patterns – patterns that can be theoretically expected in view of the type of standpoint defended, the institutional aim, and the conventions and constraints of the context. This paper aims to add a new dimension to both this line of research and research on health communication by determining whether the prototypical types of argumentation in consultations about palliative systemic treatment for advanced cancer are stereotypical as well, (...) that is, whether they are dominant in a quantitative sense. For this purpose, a valid and reliable measurement instrument is developed and used in a content analysis of the transcripts of 49 consultations. On the basis of the results of this analysis, it can be concluded that the use of symptomatic and pragmatic argumentation is stereotypical in this type of consultations. (shrink)

Models of communication,frequently used in legal semiotics, offer ananalytic framework for the relationship betweenlegal rules on the one hand and correspondingsocial behaviour on the other. Semiotic modelsseek to clarify (un)successful legalcommunication; they try to reveal the processesof interpretation and sense construction. Inthis paper, these processes are described,taking Article 96 of the Dutch Constitution asan example. Although the text of Article 96 hasremained nearly unchanged, its substantivemeaning has changed fundamentally. Thebackground and development of the `declarationof war', as laid down in Article (...) 96, areanalysed and fully elaborated. It is concludedthat the classical models of communication,largely based upon the idea of the existence ofa linear relationship between rule and conduct,hardly correspond with the complex processes asdescribed in the analysis of Article96 Communication between rule and practice isobviously more than a one-waycausality, in which rule information `flows'from sender (legislator) to receiver (citizen).The institutional model of communication,developed by Ruiter, offers a different approach.The institutional model is based on the notionof law as `institutional landscaping';realisation depends on common beliefs andgeneral acceptance. The influence of the socialpractice on the meaning of legal rules becomesan important factor. The institutional theoryseems to offer a more adequate model for thecomplex reality of legal communication. (shrink)

Pedigree dog breeding has been the subject of public debate due to health problems caused by breeding for extreme looks and the narrow genepool of many breeds. Our research aims to provide insights in order to further the animal-ethical, political and society-wide discussion regarding the future of pedigree dog breeding in the Netherlands. Guided by the question ‘How far are we allowed to interfere in the genetic make-up of dogs, through breeding and genetic modification?’, we carried out a multi-method case-driven (...) research, reviewing literature as well as identifying the perceptions of pedigree dog breeding of a variety of parties in the Netherlands. We examined what moral arguments and concepts different stakeholders, including breeders, veterinarians and animal protection societies, put forward when considering this question. While welfare arguments were often used as a final justification, we also frequently encountered arguments beyond welfare in practice, in particular the arguments that certain adaptations were unnatural, that they instrumentalised animals, or that they amounted to playing God. We argue that the way these arguments are employed points to a virtue ethical approach, foregrounding the virtue of temperance, as a balance between extreme positions was sought by our respondents in a variety of ways. Moreover, we argue against a rejection of unnaturalness arguments based on the naturalistic fallacy, as philosophers tend to do. We point out that unnaturalness arguments are related to people’s worldviews, including views on the proper human–animal relationship. We argue that such arguments, which we label ‘life-ethical’, should be the subject of more public discussion and should not be relegated to the private sphere. (shrink)

It is commonly thought that exploitation is unjust; some think it is part of the very meaning of the word ‘exploitation’ that it is unjust. Those who think this will suppose that the just society has to be one in which people do not exploit one another, at least on a large scale. I will argue that exploitation is not unjust by definition, and that a society might be fundamentally just while nevertheless being pervasively exploitative. I do think that exploitation (...) is nearly always a bad thing, and wul try to identify the moral belief which makes most of us think it is. But I will argue that its badness does not always consist in its being unjust. (shrink)

Models of communication,frequently used in legal semiotics, offeran analytic framework for the relationshipbetween legal rules on the one hand andcorresponding behaviour on the other.Semiotic models seek to clarify(un)successful legal communication; theytry to reveal the processes ofinterpretation and sense construction. Theessence of these models is that thesubstantive meaning of a rule can (orcannot) be transmitted in a `flow model'of information. The models are based upona linear causality of ruleinformation. In this paper, the processesof sense construction are described,taking the freedom of expression, (...) as laiddown in Article 7 of the DutchConstitution, as an example. Although thetext of Article 7 remained unalteredsince its first drafting in 1815, itssubstantive meaning has changedfundamentally. The transformation wascaused by complex processes that tookplace in social practice. These complexprocesses with respect to Article 7 arecompared with the transformation processesanalysed with respect to Article 96 of theDutch Constitution, published in anearlier paper. A comparison between bothArticles leads to the question: `Do weneed to construct an analytical model forlegal communication in whichreciprocal relations between legislatorand citizens are highlighted?' On thebasis of the two case studies, whichdescribe the influence of social practiceon the substantive meaning of the(textually unaltered) Articles, we have toanswer the question in the affirmative. (shrink)

Finally, some brief responses to the kind observations on my book by the three respondents, with a view to possible improvements of the model I have proposed. I began the outline of my analytical model by confronting it with that of Teubner, as mentioned in the response of Willem Witteveen. As Witteveen states, it is my goal and ambition to replace the flow model of communication (Teubner) with something new. Witteveen maintains that Teubner has already discarded the flow model of (...) communication. However, even Witteveen acknowledges (along with many others) that in the autopoiesis theory Teubner developed a one-sided communication model: that of the flow of legal rules between different social subsystems. The legal system is one such social subsystem, rule addressees are other social subsystems. Teubner’s model of legal messages concentrates basically on legal rules which aim to produce factual results in the form of behaviour conforming to the rules. The flow of legal messages takes pl .. (shrink)

Hospitalization significantly impacts the lives of older people, both physically and psychosocially. There is lack of observation studies that may provide an embodied understanding of older patients’ experiences in its context. The aim of this single case study was to reach a deeper understanding of one older patient’s lived experiences of hospitalization. The study followed a phenomenological embodied enquiry design and the qualitative observation method of shadowing was used. In April 2011, one older patient was shadowed for 7 days, 5–7 (...) h per day. To facilitate understanding in the reader the experiences are first presented in a story and subsequently analyzed by means of the lifeworld framework. The findings show that hospitalization is experienced as ambiguous safety, disconnected time, the feeling of being partially involved, and the struggle to re-attune to the body. (shrink)

This article develops a model first proposed in my book Jurisprudence and communication [67]. It takes as its starting point the generally conception that legal rules are valid norms, involving a normative content and expressing themselves in reality through observable conduct. This dualistic character of law is central. Law is both fiction and factual, ideal and real. But the viewpoint that a legal rule is a manifestation of validity in reality, through empirical acts, raises the question how rules as (valid) (...) fictions can be known and understood in their linguistic form. How is meaning attributed to the legal words and how do these words relate to the world of fact? Taking an institutional-pragmatic approach as a starting point, an analytical model is created that can be used as an instrument for the relationship between legal rules as thought objects existing only in the mind, and legal rules as observable conduct. This model seeks to revise the classical models of legal communication that basically focus on the unilateral flow of legal information between ‘senders and receivers’ and their claim of linear causality between rules and conduct. The model here constructed in the theoretical part is then applied to several case studies, in order to analyze the construction of meaning in actual use. Two fundamental rights—the older codified in 1798 and the more recent codified in 1983—in the Dutch Constitution have been analyzed using the model as an instrument. Further, the remarkable shifts in article 96 of the Constitution, the declaration of war, and its consequences, resulting in a new category of war—the armed conflict—have been analyzed, as well as the phenomenon of ‘peacekeeping missions’ involving actual warfare. The new war terminology has created vagueness with respect to the clear-cut division between war and peace, which has been reflected in several cases before Court, including the Eric O. case. The present analysis of the case studies indicates that the model was not in all cases completely tailored to the facts: for example, in the case study on article 96 a broad spectrum of observable legal and non-legal actors dominated the facts in such a way that the model did not fully cover it. The observations on my book by the three respondents in this special issue have contributed to the adaptation and extension of the model. In the Postscript my responses suggest some ways in which their ideas can be implemented. (shrink)