An important and supposedly impactful form of clinical ethics support is moral case deliberation. Empirical evidence, however, is limited with regard to its actual impact. With this literature review, we aim to investigate the empirical evidence of MCD, thereby a) informing the practice, and b) providing a focus for further research on and development of MCD in healthcare settings. A systematic literature search was conducted in the electronic databases PubMed, CINAHL and Web of Science. Both the data collection and the (...) qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of our decisions. The qualitative analysis was supported by ATLAS.ti. Based on a qualitative analysis of 25 empirical papers, we identified four clusters of themes: 1) facilitators and barriers in the preparation and context of MCD, i.e., a safe and open atmosphere created by a facilitator, a concrete case, commitment of participants, a focus on the moral dimension, and a supportive organization; 2) changes that are brought about on a personal and inter-professional level, with regard to professional’s feelings of relief, relatedness and confidence; understanding of the perspectives of colleagues, one’s own perspective and the moral issue at stake; and awareness of the moral dimension of one’s work and awareness of the importance of reflection; 3) changes that are brought about in caring for patients and families; and 4) changes that are brought about on an organizational level. This review shows that MCD brings about changes in practice, mostly for the professional in inter-professional interactions. Most reported changes are considered positive, although challenges, frustrations and absence of change were also reported. Empirical evidence of a concrete impact on the quality of patient care is limited and is mostly based on self-reports. With patient-focused and methodologically sound qualitative research, the practice and the value of MCD in healthcare settings can be better understood, thus making a stronger case for this kind of ethics support. (shrink)

BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES (...) practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions.ResultsThe main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices.ConclusionsThe evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA. (shrink)

Business Ethics: A European Review, Volume 30, Issue 2, Page 188-201, April 2021.

Business Ethics: A European Review, Volume 30, Issue 2, Page 188-201, April 2021.

Queen pheromones, which signal the presence of a fertile queen and induce daughter workers to remain sterile, are considered to play a key role in regulating the reproductive division of labor of insect societies. Although queen pheromones were long thought to be highly taxon‐specific, recent studies have shown that structurally related long‐chain hydrocarbons act as conserved queen signals across several independently evolved lineages of social insects. These results imply that social insect queen pheromones are very ancient and likely derived from (...) an ancestral signalling system that was already present in their common solitary ancestors. Based on these new insights, we here review the literature and speculate on what signal precursors social insect queen pheromones may have evolved from. Furthermore, we provide compelling evidence that these pheromones should best be seen as honest signals of fertility as opposed to suppressive agents that chemically sterilize the workers against their own best interests. (shrink)

Current dynamic-epistemic logics model different types of information change in multi-agent scenarios. We generalize these logics to a probabilistic setting, obtaining a calculus for multi-agent update with three natural slots: prior probability on states, occurrence probabilities in the relevant process taking place, and observation probabilities of events. To match this update mechanism, we present a complete dynamic logic of information change with a probabilistic character. The completeness proof follows a compositional methodology that applies to a much larger class of dynamic-probabilistic (...) logics as well. Finally, we discuss how our basic update rule can be parameterized for different update policies, or learning methods. (shrink)

The concept of affordances is rapidly gaining traction in the philosophy of mind and cognitive sciences. Affordances are opportunities for action provided by the environment. An important open question is whether affordances can be used to explain mental action such as attention, counting, and imagination. In this paper, we critically discuss McClelland’s (‘The Mental Affordance Hypothesis’, 2020, Mind, 129(514), pp. 401–427) mental affordance hypothesis. While we agree that the affordance concept can be fruitfully employed to explain mental action, we argue (...) that McClelland’s mental affordance hypothesis contain remnants of a Cartesian understanding of the mind. By discussing the theoretical framework of the affordance competition hypothesis, we sketch an alternative research program based on the principles of embodied cognition that evades the Cartesian worries. We show how paradigmatic mental acts, such as imagination, counting, and arithmetic, are dependent on sensorimotor interaction with an affording environment. Rather than make a clear distinction between bodily and mental action, the mental affordances highlight the embodied nature of our mental action. We think that in developing our alternative research program on mental affordances, we can maintain many of the excellent insights of McClelland’s account without reintroducing the very distinctions that affordances were supposed to overcome. (shrink)

A variety of logical frameworks have been developed to study rational agents interacting over time. This paper takes a closer look at one particular interface, between two systems that both address the dynamics of knowledge and information flow. The first is Epistemic Temporal Logic (ETL) which uses linear or branching time models with added epistemic structure induced by agents’ different capabilities for observing events. The second framework is Dynamic Epistemic Logic (DEL) that describes interactive processes in terms of epistemic event (...) models which may occur inside modalities of the language. This paper systematically and rigorously relates the DEL framework with the ETL framework. The precise relationship between DEL and ETL is explored via a new representation theorem characterizing the largest class of ETL models corresponding to DEL protocols in terms of notions of Perfect Recall , No Miracles , and Bisimulation Invariance . We then focus on new issues of completeness . One contribution is an axiomatization for the dynamic logic of public announcements constrained by protocols, which has been an open problem for some years, as it does not fit the usual ‘reduction axiom’ format of DEL. Finally, we provide a number of examples that show how DEL suggests an interesting fine-structure inside ETL. (shrink)

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)

Amsterdam University Press is a leading publisher of academic books, journals and textbooks in the Humanities and Social Sciences. Our aim is to make current research available to scholars, students, innovators, and the general public. AUP stands for scholarly excellence, global presence, and engagement with the international academic community.

Many logical systems today describe intelligent interacting agents over time. Frameworks include Interpreted Systems (IS, Fagin et al. [8]), Epistemic-Temporal Logic (ETL, Parikh & Ramanujam [22]), STIT (Belnap et al. [5]), Process Algebra and Game Semantics (Abramsky [1]). This variety is an asset, as different modeling tools can be fine-tuned to specific applications. But it may also be an obstacle, when barriers between paradigms and schools go up. This paper takes a closer look at one particular interface, between two systems (...) that both address the dynamics of knowledge and information flow in multi-agent systems. One is IS/ETL (IS and ETL are, from a technical point of view, the same up to model transformations, cf. [20]), which uses linear or branching time models with added epistemic structure induced by agents’ different capabilities for observing events. These models provide a Grand Stage where histories of some process unfold constrained by a protocol, and a matching epistemic-temporal language describes what happens. The other framework is Dynamic Epistemic Logic (DEL, [10, 4, 34]) that describes interactive processes in terms of epistemic event models which may occur inside modalities of the language. Temporal evolution is then computed from some initial epistemic model through a process of successive ‘product updates’. It has long been unclear how to best compare IS/ETL and DEL. Various aspects have been investigated in [10, 30, 32], but in this paper, we study the interface in a more systematic way. Often, DEL and ETL are presented as alternative ways of adding dynamics to multi-agent epistemic models. In this paper, we rather focus on how merging the two different modeling choices leads to interesting new questions. Our leading interest here will be a view of informational processes as evolving over time. To see what we mean, consider the simplest version of DEL, viz. the logic of public announcements PAL ([23]) which adds a very specific type of communicative 1 action to epistemic models: a public announcement.. (shrink)

Since 2013, mortgage advisory has become an independent profession in the Netherlands. Initially working for mortgage providers, the newly nonpartisan advisers now work for standard advisory fees, thereby reducing conflicts of interest. In this article, I provide an ethical analysis of the different types of ethos of mortgage advisers, that is, the ways they see and talk about, and relate to their work in a certain way. The central research question is: What different kinds of ethos do mortgage advisers have, (...) and which moral dilemmas do they experience in their advisory work? The existence of moral dilemmas is controversial in ethics but nonetheless experienced in real-world business practice. An “ethological” understanding of morality is developed in this paper to understand how these dilemmas are experienced. Twenty-nine mortgage advisers have participated in Q methodological research, a mixed qualitative–quantitative small-sample method. Three different types of ethos were found: Principled Advisers, Moral Advisers, and Minimal Morality Advisers. In considering these three types, I argue that many mortgage advisers should professionalize their ethical stance and learn to address situations in which moral values are neglected. Business ethicists, in turn, need to acknowledge that something may be considered morally inappropriate but is still defensible in some other sense. In this paper, I develop a “layered” conception of business ethics that broadens the perspective from universal notions, such as “rights” and “duties,” toward a concrete ethos that people have in a certain professional practice. (shrink)

Populist attributions of blame have important effects on citizens’ attitudes, cognitions, emotions, and behaviors. Extending previous studies that have mostly looked at populist messages blaming political elites, we use an online survey experiment (N = 805) to investigate the effects of blaming different elitist actors in populist and non-populist ways: (1) political elites, (2) corporate elites, (3) scientific elites, and (4) a combination of these elites. We compare mere causal responsibility attribution to populist blame attributions that highlight a central opposition (...) between “pure ordinary people” and “corrupt elites” to tease out the specific effect of populist rhetoric. Results suggest that populist messages blaming all elites have stronger effects than isolated cues. Furthermore, populist blame attribution leads to more negative perceptions of the elites than non-populist blame attribution. The finding that populist frames can – under some conditions – activate negative perceptions toward different elites is alarming in times of declining trust in societal institutions, and calls for a more encompassing understanding of populists’ scapegoats. (shrink)

Background: Audio-visual teleconsultation is expected to help home-based palliative patients, hospital-based palliative care professionals, and family physicians to jointly design better, pro-active care. Consensual knowledge of the possibilities and limitations of teleconsultation in transmural palliative care is, however, largely lacking.This paper aims at describing elements of both the physical workplace and the cultural-social context of the palliative care practice, which are imperative for the use of teleconsultation technologies. Methods: A semi-structured expert meeting and qualitative, open interviews were deployed to explore (...) professionals’ assumptions and wishes, which are considered to contain latent presumptions about the practice’s physical workplace and latent elements of the cultural-social context, regarding (1) the mediating potential of audio-visual teleconsultation, (2) how the audio-visual teleconsultations will affect medical practice, and (3) the design and usage of the teleconsultation technology. We used a qualitative analysis to investigate how palliative care professionals interpret the teleconsultation package in preparation. The analysis entailed open and axial coding techniques developed in a grounded theory approach. Results: Respondents assume: 1. teleconsultation will hinder physical proximity, thereby compromising anamnesis and diagnosis of new or acutely ill patients as well as “real contact” with the person behind the patient; 2. teleconsultation will help patients becoming more of a pivotal figure in their own care trajectory; 3. they can use teleconsultation to keep a finger on the pulse; 4. teleconsultations have a healing effect of their own due to offered time and digital attention; 5. teleconsultation to open up an additional “gray” network outside the hierarchical structures of the established chain of transmural palliative care. This network could cause bypassing of caregivers and uncertainty about responsibilities; 6. teleconsultations lead to an extended flow of information which helps palliative care professionals to check the stories of patients and medical specialists. Conclusions: Professionals assume teleconsultation co-defines a new patient–professional relationship by extending hospital-based caregivers’ perceptions of as well as attention for their patients. At the cost, however, of clinical and personal connectedness. Secondly, a hermeneutics is needed to carefully interpret teleconsultation images. Thirdly, teleconsultations transform caregiving cultures as formerly separated care domains collide, demanding a redefinition of roles and responsibilities. (shrink)

This anthology examines the practical role of well-being in contemporary society. It discusses developments such as globalization, consumerism and the rapid innovation and use of new and emerging technologies and focuses on the significant impact of these developments on the well-being of people living today. The anthology brings together researchers from various disciplines, including psychology, economics, sociology, philosophy and development studies. It provides concrete insight on the role and importance of well-being in contemporary society, using a mix of empirical grounding, (...) philosophical rigour and an emphasis on real-world applications. It is unique in that it seeks to understand the relation between well-being research and its application towards real problems. (shrink)

Educational Theory, Volume 72, Issue 1, Page 103-108, February 2022.

We are grateful for the thoughtful replies to our article. 1 We are especially encouraged that all respondents agree that it is of value to develop a theoretical framework which helps to study how clinical ethics support services (CESS) induce individual and organisational learning. We have focused on the relations between moral case deliberation (MCD), organisational learning and quality improvement from a predominantly sociological perspective. The goal of our theoretical framework was to establish hypotheses which allow for empirical evaluation of (...) the relation between CESS and quality of care. Two major concerns seem to underly the commentaries: the framework (1) lacks a normative standard which allows for ethical justification of the outcome of repeated MCD, 2 and (2) the focus on morisprudence does not sufficiently emphasise the need for ‘structured, consistent, and facilitated processes for fair and robust moral case deliberation’. 3 In other words, it... (shrink)

Kolbe and de Melo-Martin (2023) provide a much needed reflection on the methods by which we measure moral distress. Their analysis, however, gives off the impression that the measures of moral dist...

Business schools are the “nurseries” of the corporate world. This article offers an empirical analysis of the business student ethos on the basis of research conducted at three Dutch universities. A theoretical framework in the tradition of virtue ethics and dubbed “moral ethology” is used to identify the values business schools convey to their students. The central research question is: What types of ethos do Dutch business students have? Forty‐three undergraduate students participated in Q‐methodological research, a mixed qualitative–quantitative small‐sample method. (...) Five different types of ethos were generated: Do‐Good Managers, Market Managers, Searching Managers, Balancing Managers, and Radical Market Managers. Some general characteristics that apply to all the types of ethos were identified, such as the search for efficiency. It is argued that business schools should pay much more attention to the values that are endorsed in both life and business and should help students to address situations in which values are neglected. (shrink)

This article focuses on the role of unions and their influence on economic inequality. Section 2 reviews the literature regarding the union effect on wages and wage inequality. Section 3 considers the separate contributions of union power, membership composition, bargaining coordination, and wage policy. Section 4 introduces the distinction between membership and coverage, while the following two sections discuss the impact of union power on earnings inequality when coverage is either exclusive or inclusive. Section 7 discusses the rationale for unions (...) aiming for wage compression while Section 8 estimates how the presence of trade unions has influenced the extent and dynamics of earnings inequality across advanced economies during the 1980s and 1990s. For this purpose indicators have been developed for trends in equality and union presence from different sources. Section 9 concludes. (shrink)

Objectives: There are indications that institutional review board members do not find it easy to assess the risks and benefits in medical experiments, although this is their principal duty. This study examined how IRB members assessed the risk/benefit ratio of a specific phase II breast cancer clinical trial.Participants and methods: The trial was evaluated by means of a questionnaire administered to 43 members of IRBs at six academic hospitals and specialised cancer centres in the Netherlands. The questionnaire addressed: identification and (...) estimation of inconvenience, toxicity, psychosocial distress, and benefits of trial participation to patients; identification and estimation of benefits to future patients and medical science; assessment of the trial’s RBR; and assessment of its ethical acceptability.Results: Most IRB members expected trial participation to involve fairly or very serious inconvenience, fairly severe to sometimes life-threatening toxicity, and serious psychological and social consequences. Conversely, the perceived likelihood of benefits to patients was modest. Most regarded the study as important, and the balance between risks and benefits to be favourable, and believed that the protocol should be approved. The IRB members’ final judgement on the trial’s ethical acceptability was significantly correlated with their RBR assessment of the protocol.Conclusions: Because most patients who participate in clinical trials hope this will prolong their lives, it is suggested that patient information should better describe the anticipated benefits—for example, the likelihood of prolonging life. This would allow patients to make decisions regarding participation based on realistic expectations. (shrink)

The idea that the state ought to be neutral towards different conceptions of the good life has been an influential principle in liberal theory since the 1970s. It has, however, been subject to criticism by communitarians, multiculturalists and liberal perfectionists. Recently, Peter Balint has attempted to defend state neutrality against its liberal critics as the adequate interpretation of the liberal project by redefining it as a range concept. By arguing that neutrality always occurs within a specific range of permissible conceptions (...) of the good life, Balint provides a convincing rebuttal of neutrality’s critics. In this paper I argue that while neutrality as a range concept provides an adequate account of state neutrality, it also makes it vulnerable to a new line of critique. Since the range of neutrality cannot be deduced from the principle of neutrality itself, neutrality is subject to political developments beyond its own control. I will start by clarifying the notion of neutrality as a range concept. Secondly, I will demonstrate that Balint’s notion of the range concept finds ample support in the wider literature on neutrality. Thirdly, I will argue that, as a range concept, neutrality ultimately depends on politically constituted value judgments. (shrink)

Concepts such as “symbolism” and “symbolic cognition” often remain unspecified in discussions the symbolic capacities of earlier hominins. In this paper, I use conceptual tools from phenomenology to reflect on the origins of early symbolic cognition. In particular, I discuss the possible early use of pointing gestures around the time of the earliest known stone tool industries. I argue that unlike more basic social acts such as expression, gaze following, and attention-getters, which are used by extant non-human great apes, communicative (...) pointing involves key elements that are characteristic of symbolic cognition. In particular, it involves “third order intentionality” as well as “shared practice horizons”: shared frameworks of understanding which are required for the interpretation of communicative acts whose meaning is not codified indexically or iconically in the signaling behavior. In the final part, I briefly review some indications for the use of pointing gestures around the time of the Lomekwian and Oldowan industries, as a way to sustain cooperation and possibly learning by instruction. It is suggested that pointing is more complex than is standardly acknowledged, and that it may have been an important communicative act for Early Stone Age hominins in transitioning to more fully symbolic speech capacities. (shrink)

In this article, I respond to some criticisms raised in Evan Fales’ review of my book The Epistemology of Spirit Beliefs that was published in this journal. The points I will address are the following: (i) Fales’ complaint about unclarity in my epistemological position, (ii) his complaint about my insufficient presentation of alternative explanations, and (iii) his complaint about my use of the terms ‘naturalism’ and ‘naturalistic explanation’.

Responses to the COVID-19 pandemic globally disrupted lives and contributed to the exacerbation of pre-existing inequalities. Women in research were also affected. The prominent role that women played in professional and personal care duties had a detrimental effect on their research outputs, potentially hindering their career progression. Moreover, the challenges faced by women academics during the pandemic, including job loss, increased mental health issues, and the intersection of gender with other socio-demographic traits exacerbated existing gender disparities within academia. By systematically (...) scoping the qualitative literature on the experiences of women researchers during the pandemic, this study sought to explore how women experienced and reacted to the challenges generated by the COVID-19 pandemic. A qualitative meta synthesis of the included studies revealed three themes: gendered professional expectations, colliding identities and coping strategies. These themes show how gendered roles such as teaching and professional care work, associated with the hierarchical and gendered division of tasks both at home and in the workplace, made women feel unsupported and alienated as relevant agents in the academic context. The study reveals the importance of pastoral care, teaching and service work as the essential backbone of the academic infrastructure, especially in times of crises. It also exposes how productivity-focused researcher assessment criteria, rewarding mainly individual results and unrewarding of care and service work, can be viewed as perpetuating structural inequalities based on gender, parenting situations, contractual situations and background. In conclusion, this study exposes the need to proactively address the gendered practices and implicit biases which reproduce inequalities within academia and highlights how paying attention to the experiences and needs of women researchers is essential for improving the resilience and crises preparedness of academic the system. (shrink)

Background Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture. Methods To identify key ethical considerations (...) arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher’s Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers. Results After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals. Conclusions The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies. (shrink)

IntroductionInternational sharing of health data opens the door to the study of the so-called ‘Big Data’, which holds great promise for improving patient-centred care. Failure of recent data sharing initiatives indicates an urgent need to invest in societal trust in researchers and institutions. Key to an informed understanding of such a ‘social license’ is identifying the views patients and the public may hold with regard to data sharing for health research.MethodsWe performed a narrative review of the empirical evidence addressing patients’ (...) and public views and attitudes towards the use of health data for research purposes. The literature databases PubMed, Embase, Scopus and Google Scholar were searched in April 2019 to identify relevant publications. Patients’ and public attitudes were extracted from selected references and thematically categorised.ResultsTwenty-seven papers were included for review, including both qualitative and quantitative studies and systematic reviews. Results suggest widespread—though conditional—support among patients and the public for data sharing for health research. Despite the fact that participants recognise actual or potential benefits of data research, they expressed concerns about breaches of confidentiality and potential abuses of the data. Studies showed agreement on the following conditions: value, privacy, risk minimisation, data security, transparency, control, information, trust, responsibility and accountability.ConclusionsOur results indicate that a social license for data-intensive health research cannot simply be presumed. To strengthen the social license, identified conditions ought to be operationalised in a governance framework that incorporates the diverse patient and public values, needs and interests. (shrink)