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The expression that professionals should be led by their moral or ethical compass is increasingly used by academics, policy makers, professionals, and educational institutes. Dutch universities of applied sciences (UAS), for example, explicitly aim to educate their students to become professionals equipped with a moral compass. This moral or ethical compass is a metaphor of which people intuitively grasp its meaning, but our literature review also shows that various interpretations are possible. We found three clusters of proposed ethical compasses expressing (...) its a) content, b) form, or c) use, which we present in this article. Thereafter, we evaluate which compass can meaningfully assist (young) professionals and, therefore, should be part of the aims and content of education provided by UAS. Based on this evaluation, we describe the possibilities and boundaries of UAS’ contribution to the development of their students’ ethical compass. (shrink)

BackgroundA patient who fulfils the due diligence requirements for euthanasia, and is medically suitable, is able to donate his organs after euthanasia in Belgium, the Netherlands and Canada. Since 2012, more than 70 patients have undergone this combined procedure in the Netherlands. Even though all patients who undergo euthanasia are suffering hopelessly and unbearably, some of these patients are nevertheless willing to help others in need of an organ. Organ donation after euthanasia is a so-called donation after circulatory death (DCD), (...) Maastricht category III procedure, which takes place following cardiac arrest, comparable to donation after withdrawal of life sustaining therapy in critically ill patients. To minimize the period of organ ischemia, the patient is transported to the operating room immediately after the legally mandated no-touch period of 5 min following circulatory arrest. This means that the organ donation procedure following euthanasia must take place in the hospital, which appears to be insurmountable to many patients who are willing to donate, since they already spent a lot of time in the hospital. Case presentationThis article describes the procedure of organ donation after euthanasia starting at home (ODAEH) following anesthesia in a former health care professional suffering from multiple system atrophy. This case is unique for at least two reasons. He spent his last conscious hours surrounded by his family at home, after which he underwent general anaesthesia and was intubated, before being transported to the hospital for euthanasia and organ donation. In addition, the patient explicitly requested the euthanasia to be performed in the preparation room, next to the operating room, in order to limit the period of organ ischemia due to transport time from the intensive care unit to the operating room. The medical, legal and ethical considerations related to this illustrative case are subsequently discussed.ConclusionsOrgan donation after euthanasia is a pure act of altruism. This combined procedure can also be performed after the patient has been anesthetized at home and during transportation to the hospital. (shrink)

The aim of this empirical study is to understand how bachelor students at universities of applied sciences (UAS) use their ethical compasses during internships. Semi-structured interviews were held with 36 fourth-year bachelor students across four UAS and three different programs in the Netherlands: Initial Teacher Education, Business Services, and Information and Communication Technology. To our knowledge, no studies appear to have investigated and compared students from multiple professional fields, nor identified the dynamics and the sequence of the strategies in the (...) decision-making process that students use when faced with ethical dilemmas during internships. We found that students’ ethical dilemmas stemmed from: mentors’ or managers’ behaviours/requests, colleagues’ behaviours, organisations’ morally questionable incentives, pupils’ home situations, and pupils’ behaviours/personal stories. The majority of students used multiple strategies and first investigated the ethical dilemmas they encountered and then avoided, intervened, delegated responsibilities, or adjusted to their environments. Students’ values played an important role in experiencing an ethical dilemma, however, these values were not always acted upon. We identified that rather students’ beliefs about having influence and/or ownership (or not), personal interest(s) and power relations influenced the way how they used their ethical compasses. Thus, instead of navigating on moral standards (of their profession), students reacted on beliefs which reflected the ways in which they constructed their internship contexts, social relationships and their own (and others) needs. As a result, half of the mentioned dilemmas were resolved in a prudent-strategic manner (e.g., by prioritising personal interests), instead of morally. This indicates that students did not always convert (moral) values into moral action and did not use their ethical compasses in the way UAS aspires. Finally, this study found that the ways in which students used their ethical compasses were strongly influenced by their environments. (shrink)

In this empirical study, we investigate _what_ and _how_ teachers in Dutch universities of applied sciences (UAS) think they contribute to the development of students’ ethical compasses. Six focus groups were conducted with teachers across three programmes: Initial Teaching Education, Business Services, and Information and Communication Technology. This study revealed that teachers across the three different professional disciplines shared similar ideas about what should be addressed in the development of students’ ethical compasses. Their contributions were grouped into three core themes: (...) creating students’ moral awareness, developing students’ moral skills and promoting students’ moral professional behaviour. The majority of the teachers used a wide range of planned and unplanned pedagogic–didactic actions (reflecting individual learning and cooperative and group learning) to enhance the development of students’ ethical compasses. However, teachers’ strategies were mostly unstructured and unreflective and depended on the individual teacher’s ability and knowledge to address moral themes. Furthermore, the study revealed two incompatible ideals: as role models, the teachers aimed to exemplify explicitly how to be a professional with an ethical compass. However, they also wanted to adopt a neutral stance because they were afraid to manipulate the students’ ethical compasses. Therefore, they avoided promoting _the_ ethical compass that they believed to be the best. (shrink)

The question we raise in this paper is, whether patient involvement might be a beneficial way to help determine and achieve the aims of translational research and, if so, how to proceed. TR is said to ensure a more effective movement of basic scientific findings to relevant and useful clinical applications. In view of the fact that patients are supposed to be the primary beneficiaries of such translation and also have relevant knowledge based on their experience, listening to their voice (...) early on in the innovation process might very well increase the effectiveness of the translation. After explaining how the concept of TR emerged and what it entails, this paper shows through a literature review which arguments have been put forward to promote patient involvement in health care research in a more general sense. We examine whether, and if so how, these arguments are relevant for the discourse on TR and we identify pitfalls and dilemmas. Ultimately, we conclude that it may be worthwhile to experiment with patient involvement in TR but that the design of such involvement requires careful consideration. (shrink)

An important discussion in contemporary ethics concerns the relevance of empirical research for ethics. Specifically, two crucial questions pertain, respectively, to the possibility of inferring normative statements from descriptive statements, and to the danger of a loss of normativity if normative statements should be based on empirical research. Here we take part in the debate and defend integrated empirical ethical research: research in which normative guidelines are established on the basis of empirical research and in which the guidelines are empirically (...) evaluated by focusing on observable consequences. We argue that in our concrete example normative statements are not derived from descriptive statements, but are developed within a process of reflection and dialogue that goes on within a specific praxis. Moreover, we show that the distinction in experience between the desirable and the undesirable precludes relativism. The normative guidelines so developed are both critical and normative: they help in choosing the right action and in evaluating that action. Finally, following Aristotle, we plead for a return to the view that morality and ethics are inherently related to one another, and for an acknowledgment of the fact that moral judgments have their origin in experience which is always related to historical and cultural circumstances. (shrink)

Most language learners have difficulties acquiring the phonemes of a second language (L2). Unfortunately, they are often judged on their L2 pronunciation, and segmental inaccuracies contribute to miscommunication. Therefore, we aim to determine how to facilitate phoneme acquisition. Given the close relationship between speech and co-speech gesture, previous work unsurprisingly reports that gestures can benefit language acquisition, e.g., in (L2) word learning. However, gesture studies on L2 phoneme acquisition present contradictory results, implying that both specific properties of gestures and phonemes (...) used in training, and their combination, may be relevant. We investigated the effect of phoneme and gesture complexity on L2 phoneme acquisition. In a production study, Dutch natives received instruction on the pronunciation of two Spanish phonemes, /u/ and /θ/. Both are typically difficult to produce for Dutch natives because their orthographic representation differs between both languages. Moreover, /θ/ is considered more complex than /u/, since the Dutch phoneme inventory contains /u/ but not /θ/. The instruction participants received contained Spanish examples presented either via audio-only, audio-visually without gesture, audio-visually with a simple, pointing gesture, or audio-visually with a more complex, iconic gesture representing the relevant speech articulator(s). Preceding and following training, participants read aloud Spanish sentences containing the target phonemes. In a perception study, Spanish natives rated the target words from the production study on accentedness and comprehensibility. Our results show that combining gesture and speech in L2 phoneme training can lead to significant improvement in L2 phoneme production, but both gesture and phoneme complexity affect successful learning: Significant learning only occurred for the less complex phoneme /u/ after seeing the more complex iconic gesture, whereas for the more complex phoneme /θ/, seeing the more complex gesture actually hindered acquisition. The perception results confirm the production findings and show that items containing /θ/ produced after receiving training with a less complex pointing gesture are considered less foreign-accented and more easily comprehensible as compared to the same items after audio-only training. This shows that gesture can facilitate task performance in L2 phonology acquisition, yet complexity affects whether certain gestures work better for certain phonemes than others. (shrink)

Biomedical research policy in recent years has often tried to make such research more ‘translational’, aiming to facilitate the transfer of insights from research and development to health care for the benefit of future users. Involving patients in deliberations about and design of biomedical research may increase the quality of R&D and of resulting innovations and thus contribute to translation. However, patient involvement in biomedical research is not an easy feat. This paper discusses the development of a method for involving (...) patients in biomedical research aiming to address its main challenges.After reviewing the potential challenges of patient involvement, we formulate three requirements for any method to meaningfully involve patients in biomedical research. It should enable patients to put forward their experiential knowledge, to develop a rich view of what an envisioned innovation might look like and do, and to connect their experiential knowledge with the envisioned innovation. We then describe how we developed the card-based discussion method ‘Voice of patients’, and discuss to what extent the method, when used in four focus groups, satisfied these requirements. We conclude that the method is quite successful in mobilising patients’ experiential knowledge, in stimulating their imaginaries of the innovation under discussion and to some extent also in connecting these two. More work is needed to translate patients’ considerations into recommendations relevant to researchers’ activities. It also seems wise to broaden the audience for patients’ considerations to other actors working on a specific innovation. (shrink)

We would like to respond to the comment we received from our colleagues on our case report about organ donation after euthanasia starting at home. We reply to their statements on medical and legal aspects, and provide more information on our view of informed consent.

Neuroscience and the Illusion of Free WillCurrently, few neuroscientists and philosophers still defend the claim that neuroscience has shown the brain ‘decides’ what we do and that free will is an illusion. This does not imply, however, that this kind of neuroscientific researchcould notsay anything about the existence of free will. Neuroscience can offer insights in the unconscious causes and underlying processes of our actions and, because of this, could perhaps show whether we act out of free will or not. (...) In this paper I will argue that in this regard the possibilities of neuroscientific research are limited. I understand free will, in line with Dana Nelkin and Susan Wolf, as the ability to do the right thing for the right reasons. I will show that whether someone acts intentionally, what it is that she is doing, and for which reasons she acts cannot be determined by studying unconscious causes or other unconscious processes related to the action. The action and reason necessarily depend on the perspective of the acting agent. Furthermore, neuroscientific research cannot show us whether the reasons and the actions areright. It could perhaps offer a unique contribution when it comes to the question of whether we areableto the right thing for the right reasons. To what extent it can remains an open question. (shrink)

Vrije wil is een raadselachtig fenomeen. Wij mensen hebben de indruk dat we zelf keuzes maken, maar de wetenschap vertelt een heel ander verhaal: onze handelingen zijn slechts het resultaat van onze persoonlijke eigenschappen, onbewuste associaties en hersenprocessen. Ons bewuste zelf is niets meer dan een passieve toeschouwer. Het is dan ook niet verrassend dat wetenschappelijk onderzoek vaak uitmondt in determinisme of ‘willusionisme’. -/- Maar wat is vrije wil eigenlijk? En wat betekent het om zelf te kiezen? In Mijn intenties (...) en ik verkent Lieke Asma vrije wil en legt ze nauwgezet uit hoe we over de vrijheid van onze eigen keuzes en handelingen moeten nadenken. Wat blijkt? Filosofisch onderzoek en het in ogenschouw nemen van het perspectief van de handelende persoon zijn essentieel voor een goed begrip van vrije wil. (shrink)

BackgroundWith advances in sequencing technologies, increasing numbers of people are being informed about a genetic disease identified in their family. In current practice, probands are asked to inform at-risk relatives about the diagnosis. However, previous research has shown that relatives are sometimes not informed due to barriers such as family conflicts. Research on family communication in genetic diseases aims to explore the difficulties encountered in informing relatives and to identify ways to support probands in this.Main bodyResearch on family communication may (...) also reveal that participants did not inform their relatives about the risk of a serious genetic condition, even when preventive and treatment options are available. Researchers may then face a dilemma: Do they need to warn at-risk relatives about the finding? Or do they keep silent due to prior confidentiality agreements with study participants?ConclusionsWe believe that the absolute confidence promised to research participants outweighs the interests of their relatives, even though it can be claimed that relatives at risk of a genetic disease do, in principle, have a right to know information collected about their health. Not respecting confidentiality agreements could cause distrust between researchers and research participants and possibly harm the relationship between probands and relatives. Relatives' health interests can still be taken into account without jeopardizing participant trust, by considering alternative scenarios, including sharing general study findings on the barriers participants experience with their healthcare professionals and by offering participants psychosocial support for family communication. (shrink)

Waarom je denkt objectief en rechtvaardig te zijn, maar dat toch niet bent. -/- We kunnen mensen onrechtvaardig behandelen zonder het te willen, en zelfs zonder het op te merken. Onbewust en ongewild maken we onderscheid tussen personen op basis van hun gender, etniciteit, leeftijd, lichaamsgewicht of seksuele oriëntatie. Hoe kan het dat ons zelfbeeld zo afwijkt van ons gedrag? -/- Het antwoord lijkt helder: in het onbewuste liggen vooroordelen opgeslagen, die ongemerkt onze gedachten, gevoelens en beslissingen beïnvloeden. Maar is (...) dat wel de juiste manier om over deze problematiek na te denken? Is het wel behulpzaam om de blik naar binnen te richten? Filosoof en psycholoog Lieke Asma pleit voor een radicaal ander perspectief. Om oog te krijgen voor onze blinde vlekken, moeten we de aandacht juist verplaatsen naar de wereld buiten ons. Alleen door te kijken naar patronen in gedrag, keuzes en reacties, en door te luisteren naar ervaringen van anderen kunnen we discriminatie herkennen en voorkomen. (shrink)

Isolated habitats, the consequence of the fragmentation process, are the object of external disturbance. This divides the patch area into two zones: interior and edge. The interior-to-edge ratio quantifies the potential disturbance impact. A method is presented to calculate a reference value for the interior-to-edge ratio, based upon the minimum edge for a given interior. The method is based on pixel geometry features and mathematical morphology. A corrected interior-to-edge ratio is defined using the reference value. The method is illustrated for (...) woodlot fragments in the Belgian Kempen region. (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)

In this article, we develop a bimodal perspective on possibility semantics, a framework allowing partiality of states that provides an alternative modelling for classical propositional and modal logics. In particular, we define a full and faithful translation of the basic modal logic K over possibility models into a bimodal logic of partial functions over partial orders, and we show how to modulate this analysis by varying across logics and model classes that have independent topological motivations. This relates the two realms (...) under comparison both semantically and syntactically at the level of derivations. Moreover, our analysis clarifies the interplay between the complexity of translations and axiomatizations of the corresponding logics: adding axioms to the target bimodal logic simplifies translations, or vice versa, complex translations can simplify frame conditions. We also investigate a transfer of first-order correspondence theory between possibility semantics and its bimodal counterpart. Finally, we discuss the conceptual trade-off between giving translations and giving new semantics for logical systems, and we identify a number of further research directions to which our analysis gives rise. (shrink)