We apply the theory of partial algebras, following the approach developed by Van Alten, to the study of the computational complexity of universal theories of monotonic and normal modal algebras. We show how the theory of partial algebras can be deployed to obtain co-NP and EXPTIME upper bounds for the universal theories of, respectively, monotonic and normal modal algebras. We also obtain the corresponding lower bounds, which means that the universal theory of monotonic modal algebras is co-NP-complete and the universal (...) theory of normal modal algebras is EXPTIME-complete. It also follows that the quasi-equational theory of monotonic modal algebras is co-NP-complete. While the EXPTIME upper bound for the universal theory of normal modal algebras can be obtained in a more straightforward way, as discussed in the paper, due to its close connection to the equational theory of normal modal algebras with the universal modality operator, the technique based on the theory of partial algebras is applicable to the study of universal theories of algebras corresponding to a wide range of logics with intensional operators, where no such connection is available. (shrink)

BackgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.MethodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19. ResultsThree (...) hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.ConclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care. (shrink)

We study the computational complexity of the universal and quasi-equational theories of classes of bounded distributive lattices with a negation operation, i.e., a unary operation satisfying a subset of the properties of the Boolean negation. The upper bounds are obtained through the use of partial algebras. The lower bounds are either inherited from the equational theory of bounded distributive lattices or obtained through a reduction of a global satisfiability problem for a suitable system of propositional modal logic.

The transits of Venus in 1761 and 1769 appear to mark the starting point of instrumental science in the Dutch East Indies (now Indonesia). This essay examines the conditions that triggered and constituted instrumental and institutional science on Indonesian soil in the late eighteenth century. In 1765 the Reverend J. M. Mohr, whose wife had received a large inheritance, undertook to build a fully equipped private observatory in Batavia (now Jakarta). There he made several major astronomical and meteorological observations. Mohr’s (...) initiative inspired other Europeans living on Java around 1770 to start a scientific movement. Because of the lack of governmental and other support, it was not until 1778 that this offspring of the Dutch‐Indonesian Enlightenment became a reality. The Bataviaasch Genootschap van Kunsten en Wetenschappen tried from the beginning to put into effect the program Mohr had outlined. The members even bought his instruments from his widow, intending to continue his measurements. For a number of reasons, however, this instrumental program was more than the society could support. Around 1790 instrumental science in the former Dutch East Indies came to a standstill, not to be resumed for several decades. (shrink)

The American Academy of Pediatrics recently released a policy statement and technical report on circumcision, in both of which the organisation suggests that the health benefits conferred by the surgical removal of the foreskin in infancy definitively outweigh the risks and complications associated with the procedure. While these new documents do not positively recommend neonatal circumcision, they do paradoxically conclude that its purported benefits ‘justify access to this procedure for families who choose it,’ claiming that whenever and for whatever reason (...) it is performed, it should be covered by government health insurance. The policy statement and technical report suffer from several troubling deficiencies, ultimately undermining their credibility. These deficiencies include the exclusion of important topics and discussions, an incomplete and apparently partisan excursion through the medical literature, improper analysis of the available information, poorly documented and often inaccurate presentation of relevant findings, and conclusions that are not supported by the evidence given. (shrink)

AbstractAgroecosystems in the Midwestern United States are undergoing changes that pressure farmers to adapt their farming practices. Because farmers decide what practices to implement on their land, there are needs to understand how they adapt to competing demands of changes in global markets, technology, farm sizes, and decreasing rural populations. Increased understanding of farmer decision-making can also inform agricultural policy in ways that encourage farmer adoption of sustainable practices. In this research we adopt a grounded view of farmers by interpreting (...) their decision-making through their stories of everyday life. We use a narrative analysis to identify recurrent themes that characterize farmer decisions as active negotiations between the demands of efficiency in maximizing crop yields with a desire to steward land through past, present, and future generations. Together these narratives portray farmer decisions as a place-making process that seeks compatibility among distinct aspirations for their land. (shrink)

In the Netherlands, the legalization of assisted suicide for persons with a death wish without severe illness, often referred to as persons with “completed life” or “tiredness of life,” is intensel...

The issue of the allocation of resources in health care is here to stay. The goal of this study was to explore the views of physicians on several topics that have arisen in the debate on the allocation of scarce resources and to compare these with the views of policy makers. We asked physicians and policy makers to participate in an interview about their practices and opinions concerning factors playing a role in decision making for patients in different age groups. (...) Both physicians and policy makers recognised allocation decisions as part of their reality. One of the strong general opinions of both physicians and policy makers was the rejection of age discrimination. Making allocation decisions as such seemed to be regarded as a foreign entity to the practice of medicine. In spite of the reluctance to make allocation decisions, physicians sometimes do. This would seem to be only acceptable if it is justified in terms of the best interests of the patient from whom treatment is withheld. (shrink)

This article researches how a corporate code of ethics (CCE) implemented in local government X has influenced the behavior of its employees, middle managers, and managers. Metaphors from the existing and desired CCE elicited by these three groups provided information on how to improve the effectiveness of the CCE. This method proved to be very fruitful. It appeared that continuous systematic attention needed to be paid to the CCE after the CCE had been implemented, particularly by management. Initiatives from management (...) to start discussions about relevant questions of integrity appeared to be also necessary to make the topic a “normal” topic which employees were no longer afraid to discuss. In this way, the possibility could be created to develop collectively a “practical” frame of reference concerning relevant questions of integrity that would help employees to make decisions in difficult situations during their work in the future. (shrink)

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)

Slow euthanasia or a good palliative intervention?There are many ways in which doctors influence the circumstances and/or the timing of a patient’s death. Some of these are accepted as normal medical practice—for instance, when a disproportional treatment is forgone, others are considered tolerable only under strict conditions or even intolerable, such as non-voluntary active euthanasia. A relatively new phenomenon in the ethical discussion on end-of-life decisions is terminal sedation. Terminal sedation is used in patients with terminal illnesses where normal medical (...) treatments cannot relieve severe symptoms such as pain and agitation, and no option is left but to take away the perception of these symptoms. Often, the decision to start terminal sedation is accompanied by the decision to forgo the provision of artificial nutrition and hydration in these patients. In The Netherlands, terminal sedation was estimated to be applied in 4–10% of all deaths in 2001.1 The combination of these two decisions have made the moral status of terminal sedation the subject of fierce ethical debates. Is it slow euthanasia2,3 or is it a good palliative intervention that should be sharply distinguished from euthanasia?4,5 One of the characteristics of this debate is that it is a very confused one: people disagree about the meaning of the term, the appropriateness of it and, of course, about the conditions under which it would be morally justified. As a matter of fact, these three discussions are deeply connected: as is often the case, a discussion about terms is a discussion about norms in disguise.The first observation to be made is that many seemingly descriptive definitions of terminal sedation contain normative claims. Examples of this are definitions of terminal sedation in which only …. (shrink)

Vaccination policy is an ethically challenging domain of public policy. It is a matter of collective importance that reaches into the most private sphere of citizens and unavoidably conflicts with individual-based ethics. Policy makers need to walk a tight rope in order to complement utilitarian public health values with individual autonomy rights, protection of privacy, non-discrimination and protection of the worst-off. Whether vaccination is voluntary or compulsory, universal or targeted, every option faces complex ethical hurdles because of the interdependence of (...) humans in infectious disease matters. In this article, we explore the following three policy questions. (i) Ethically, which policy measures should be addressed when vaccination coverage is insufficient in a population? Information campaigns, legal compulsion, or the use of financial incentives can all be effective, but also controversial policy options. (ii) Is it ethical to target vaccination programs at certain risk-groups? If such measures are necessary, we argue that policymakers will often have to decide which is more important to uphold: non-discrimination or the protection of privacy. And (iii), what is the ethical significance of adverse herd immunity effects? Some vaccination programs will improve average population health, but will at the same time increase the risk of severe morbidity and mortality for individuals in the worst-off groups of society. (shrink)

This paper challenges a pervasive, if not always explicit assumption of the present state of theorising in business ethics. This is the idea that a workable theory of organizational ethics must provide a unified perspective on its subject matter. In this paper we will sketch the broad outlines of an alternative understanding of business ethics, which focuses on constraints on corporate conduct that cannot reasonably be rejected. These constraints stem from at least three different levels or spheres of social reality, (...) i.e. the preconditions of a well-ordered society, the internal morality of economic activity and the preconditions of autonomous agency. (shrink)

Background: Caring for terminally ill patients is a meaningful task, however the patient’s suffering can be a considerable burden and cause of frustration.Objectives: The aim of this study is to describe the experiences of general practitioners in The Netherlands in dealing with a request for euthanasia from a terminally ill patient.Methods: The data, collected through in-depth interviews, were analysed according to the constant comparative method.Results: Having to face a request for euthanasia when attempting to relieve a patient’s suffering was described (...) as a very demanding experience that GPs generally would like to avoid. Nearly half of the GPs strive to avoid euthanasia or physician assisted suicide because it was against their own personal values or because it was emotional burdening to be confronted with this issue. They explained that by being directed on promoting a peaceful dying process, or the quality of end-of-life of a patient by caring and supporting the patient and the relatives it was mainly possible to shorten patient’s suffering without “intentionally hastening a patient’s death on his request”. The other GPs explained that as sometimes the suffering of a patient could not be lessened they were open to consider a patient’s request for euthanasia or physician assisted suicide. They underlined the importance of a careful decision-making process, based on finding a balance between the necessity to shorten the patient’s suffering through euthanasia and their personal values.Conclusion: Dealing with requests for euthanasia is very challenging for GPs, although they feel committed to alleviate a patient’s suffering and to promote a peaceful death. (shrink)

Decentralized clinical trials (DCTs) have the potential to advance the conduct of clinical trials, but raise several ethical issues, including obtaining valid informed consent. The debate on the ethical issues resulting from digitalization is predominantly focused on direct risks relating to for example data protection, safety, and data quality. We submit however, that a broader view on ethical aspects of DCTs is needed to touch upon the new challenges that come with the DCT practice. Digitalization has impacts that go beyond (...) its direct purposes, by shaping behaviors, experiences, social relations, and values. We examine four elements of the informed consent procedure that are affected by DCTs, while taking these soft impacts of technologies into account: (i) informing participants and testing understanding, (ii) freedoms in relation to responsibilities and burdens, (iii) trust in participant-researcher relations, and (iv) impacts on the concept of privacy. Our analysis reveals that a broad view is key for optimal conduct of DCTs. In addition, it provides insight into the ethical impacts of DCTs on informed consent. Technologies such as DCTs potentially have profound impacts which are not immediately addressed by the existing regulatory frameworks, but nonetheless important to recognize. These findings can guide future practices of DCTs to foster the important values of clinical research in this novel approach for conducting clinical trials. (shrink)

In April 2002 a new law regarding euthanasia came into effect in the Netherlands. This law holds that euthanasia remains a criminal offence unless it is performed by a physician who acts according to six specified rules of due care and reports the case to a review committee. The six rules of due care are similar to those of the previous regulation and are largely based on jurisprudence. Completely new, however, is the article concerning a competent patient who has written (...) an advance directive requesting euthanasia under certain circumstances. The law stipulates that a physician may act according to that written request, as long as he or she fulfils all other rules of due care. The author defends the view that these requests are neither feasible nor ethically justifiable, and presents both moral and practical arguments for this, claiming that for consistency reasons one cannot act on the basis of a written statement and fulfil the other rules of due care at the same time. The author also examines a difficult case of a demented, severely depressed woman who had written a living will requesting euthanasia before she became demented. (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)

The term "stakeholder engagement" has gained increasing prominence over the last few years. This prominence is fueled by a range of issues such as an increased dissatisfaction with business's focus on stockholder/shareholder interests and the demands for greater transparency from business following major business scandals. A perceived response to this issue in South Africa has been the inclusion of guidelines on stakeholder engagement in the King II Report on Corporate Governance. Despite this growing interest, there has not been clarity on (...) how companies engage with their stakeholders and specifically with how they identify and prioritize their stakeholders. The study sought to establish the reporting practices of South African business in relation to stakeholder identification and prioritization through a content analysis of their annual reports. The findings are discussed and recommendations on the two aspects of stakeholder engagement presented. (shrink)

With technological possibilities in healthcare steadily increasing, more tools for digital cognitive rehabilitation become available. Acceptance of such technological advances is crucial for successful implementation. Therefore, we examined technology acceptance specifically for this form of rehabilitation in a sample of healthcare providers involved in cognitive rehabilitation. An adjusted version of the Technology Acceptance Model questionnaire was used, including the subscales for perceived usefulness, perceived ease of use, subjective norm, and intention to use, which all contribute to actual use of a (...) specific technology. Results indicate a generally favorable attitude toward the use of digital cognitive rehabilitation and positive responses toward the TAM constructs. Only for subjective norm, a neutral mean response was found, indicating that this could pose a potential obstacle toward implementation. Potential differences between subgroups of different age, gender, and professional background were assessed. Age and gender did not affect the attitude toward digital cognitive rehabilitation. Occupational therapists showed lower scores than healthcare psychologists and physiatrists with regard to perceived usefulness, possibly linked to a difference in operational and managerial tasks. The findings of his study stimulate further implementation of digital cognitive rehabilitation, where the role of subjective norms should be specifically considered. (shrink)

A recurrent issue in the vast amount of literature on reasoning models in ethics is the role and nature of moral intuitions. In this paper, we start from the view that people who work and live in a certain moral practice usually possess specific moral wisdom. If we manage to incorporate their moral intuitions in ethical reasoning, we can arrive at judgements and (modest) theories that grasp a moral experience that generally cannot be found outside the practice. Reflective equilibrium (RE) (...) provides a framework for balancing moral intuitions, ethical principles and general theories. Nevertheless, persisting problems associated with the use of intuitions need to be addressed. One is the objection that moral intuitions lack the credibility necessary to guide moral reasoning. Ethicists have tried to solve this problem by formulating criteria to separate the “bad” intuitions from the “good” ones at the beginning of the reasoning process. We call this the credible input-justified outcome strategy. An example is the appeal to the common morality by Beauchamp and Childress. We think this approach is unsuccessful. As an alternative, we outline the good reasoning-justified outcome strategy. It connects to a variant of RE in which intuitions from different sources are incorporated. We argue that the elements of RE have different levels of justificatory power at the start of reasoning. In our strategy, each element can gain or lose justificatory power when it is tested in a reasoning process that meets several criteria. (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)