Within contemporary health care, many of the decisions affecting the health and well-being of patients are not being made by the clinicians or health professionals, but by those involved in health care management. Existing literature on organizational ethics provides insight into the various structures, processes and strategies - such as mission statement, ethics committees, ethical rounds … - that exist to create an organizational climate, which fosters ethical practices and decision-making It does not, however, show how health care managers experience (...) their job as being intrinsically ethical in itself. In the present article, we investigate the way in which ethical values are present in the lived experiences and daily practice of health care management. What does it imply to take up a managing position within a health care institution and to try to do this in an ethically inspired way? We carried out a qualitative study to explore the essence of values-based leadership in health care. We interviewed 15 people with extensive experience in health care management in the fields of elderly care, hospital care and mental health care in the various regions of Flanders, Belgium. Six predominant themes, presented as metaphors, illustrate the essence of values-based leadership in health care management. These are: values-based health care management as managing a large garden, as learning and using a foreign language, going on a trekking with an ethical compass, embodying integrity and authenticity in a credible encounter with everyone, being a present and trustworthy leader during sun and storm, and contributing to human flourishing by giving people wings to fly. Notwithstanding the importance of organizing a good ethics infrastructure, values-based leadership in health care entails much more than that. It is about the co-creation of an integrated and comprehensive ethical climate of which community-model thinking and authentic leadership are essential components. As a never-ending process, the six metaphors can help leaders to take substantive proactive steps to shape a fruitful ethical climate within their organization. (shrink)
In the first phase of the research project Nanotechnologies for Tomorrow's Society, the research consortium explored a variety of futuristic visions or technoscientific imaginaries. This exploration took the form of a Policy Delphi, adapted to the particular objective of jointly constructing nano-imaginaries, taking participants' personal visions of possible future applications and societal issues as a starting point. The participants were nanoresearchers, as well as societal experts and primary involved citizens. In this article, the authors describe the theoretical frame that inspired (...) their methodological approach, present the analytical results obtained, and bring some reflections to the fore that arose as a result of the performance and analysis of this Delphi-exercise. (shrink)
The main objective of the Flemish research project ‘Nanotechnologies for tomorrow’s society’ (NanoSoc) is to develop and try out an interactive process as a suitable methodology for rendering nanoresearchers aware of underlying assumptions that guide nanotech research and integrating social considerations into the research choices they face. In particular, the NanoSoc process should sustain scientists’ capacities to address growing uncertainties on the strategic, scientific and public acceptance level. The article elaborates on these uncertainties and involved dilemmas scientists are facing and (...) proposes a process approach which addresses strategic uncertainty by alternating between ‘visioning’ and ‘technology assessment’; a process design which manages complexity by promoting reflexivity among scientists by exposing them to deliberations in civil society (social experts, stakeholders, citizens) on plausible futures with nanotechnologies; and as an answer to societal ambivalence, certain process quality requirements such as an attitude of perplexity or openness towards ‘plurality’ and an attitude of ‘temporary closure’, both in support of understanding and learning from differences. (shrink)
Quality assurance in large terminologies is a difficult issue. We present two algorithms that can help terminology developers and users to identify potential mistakes. We demonstrate the methodology by outlining the different types of mistakes that are found when the algorithms are applied to SNOMED-CT. On the basis of the results, we argue that both formal logical and linguistic tools should be used in the development and quality-assurance process of large terminologies.
We present the details of a methodology for quality assurance in large medical terminologies and describe three algorithms that can help terminology developers and users to identify potential mistakes. The methodology is based in part on linguistic criteria and in part on logical and ontological principles governing sound classifications. We conclude by outlining the results of applying the methodology in the form of a taxonomy different types of errors and potential errors detected in SNOMED-CT.
The Human Rights Act 1998 is one of the most important constitutional reforms to have been implemented by the New Labour administration in Britain. In addition to incorporating the European Convention on Human Rights into domestic law, its main ambition is the creation of a human rights culture. However, while citizens appear to have very little understanding of what the legislation entails, there is a strong tide of negative media publicity which depicts the Human Rights Act as a ‘villains’ charter’. (...) It has been suggested that the government should do more to promote human rights. This paper reflects on how this may be achieved. An important strategy for creating a positive public awareness of human rights involves eradicating myths which have been allowed to flourish in sections of the British press. However, drawing on the work of Roland Barthes, this paper argues that this may be an unattainable goal. Human rights are empty signifiers which invite mythical appropriation. Both proponents and detractors of human rights legislation mobilise this capacity for mythmaking in their rhetoric. (shrink)
Ending the influence which politicalparties exercised over judicial appointmentswas a prominent aim of the project of reformingthe Belgian criminal justice system in the1990s. However, focusing on various highprofile scandals affecting public confidence inthe judiciary, this paper questions whether thepolitical nature of the judiciary is capable ofbeing eradicated. Drawing on the work ofChantal Mouffe, this analysis starts with aconsideration of the discursive element inpolitical identity, which is furthercorroborated by the semiotics of Saussure andGreimas. Applying this perspective to theBelgian situation in the (...) 1990s, it is arguedthat a redefinition of politics in terms of an``us/them'' divide between citizens andinstitutions took place. In this process,judges were targeted as part of theestablishment and cast as the constitutiveoutside buttressing the collectiveidentification between the media, victims ofcrime and the general public. In explaining theinstitutional gap, individual traits of judgesconstituted a significant focus, as can beshown through the extraordinary visibility ofone judge who courted media attention when hewas tried for sadomasochistic activities in1997. (shrink)
In this appeal the House of Lords held that a school’s refusal to change its school uniform rules to accommodate the religious beliefs of one of its pupils did not constitute an interference with freedom of religion and the right to an education. This note asks whether the House of Lords by framing the issue as a matter of individual choice and informed consent may have underestimated the potential for social harm inflicted by a school’s unwillingness to accommodate certain types (...) of religious beliefs where it has already adapted its school uniform rules for others. (shrink)
We have sought to expound how Jan van Ruusbroec goes about representing the relationship of love between God and human beings by proceeding from God’s inner life of love. Therefore, in the first part of our paper we elucidated Ruusbroec’s view of the inner love reality of the Triune God. In the second part we explained how genuine Christian mystical life is founded within the intra-trinitarian life of love. Prior to discussing the characteristics of Ruusbroec’s trinitarian position, we dwelled upon (...) the author’s development of his idea of the Trinity from a personal perception of his relation with God, the embedding of Ruusbroec’s love-mysticism in traditional Christian faith and his repeated clarification of the Triune God from two perspectives: God’s nature and God’s essence. We found that, in his explanation of God’s nature, Ruusbroec underlines its fruitfulness as a way of demonstrating that God is one dynamic of love, without beginning or end, which ceaselessly and simultaneously consists in “flowing out” and “being flowed back”. This phenomenon, we stated, he associates with the concept, “oneness in threeness” and “threeness in oneness”. Through an exposition on the differing features of unity and the Persons of the Trinity, we came to the conclusion that the author in all of his works combines both the origin of “flowing out” and “flowing-back” with the Holy Spirit as the bond or unity of love of Father and Son. From this we concluded that none of the Persons is the principle or source of regiratio, i.e. return, to the unity. The view that God’s unity of Persons is the principle of exitus-reditus – and not only the third Person as recent scientific research has sought to demonstrate – is what we consider to be the heart of Ruusbroec’s trinitarian way of thinking. We ascertained, further, that the author not only links the unity of the Persons with fruitfulness; he believes that the same “fruitful” unity, drawing in the divine Persons on the level of God’s nature, is the “enjoying” unity on the level of God’s essence. By means of the distinction between God’s enjoying unity and the unity of God’s fruitful nature, Ruusbroec explicates the true facts of the intra-trinitarian life of love. The perception leads him to conclude that God, as a unity of Persons, is ceaselessly and simultaneously working and enjoying. In the second part, we illustrated how Ruusbroec’s trinitarian thought mirrors the basis of his mystical doctrine: the conviction that mystics are unified with the divine Persons both in working and enjoying, and that they are one reality of love with God. We explained how the author, first of all, maintains that mystics, who bear a full likeness to God’s fruitful nature, ceaselessly turn to good works and virtues, just as God, ceaselessly, through the divine Persons, flows out in love. We then avered that the likeness to God’s nature is not the result of human effort and that it arises from God’s touch within the human mind. Moreover, we showed that Ruusbroec, in accordance with his intuition that God’s fruitful unity is both out-flowing and inwarddrawing, believes that God is both impelling humans outward toward virtues and drawing them into God’s unity of love. In analogy with the first part of our argument – as far as the “return” of humans is concerned – we ascertained that our author is stressing the initiative of God’s unity of the Holy Spirit, i.e. the mutual love between the Father and the Son. We found the emphasis on God’s inward-drawing unity to be of great significance, because God’s unity of love also plays a crucial role with respect to the transition to “enjoyment” of human beings in God’s essence. We clarified how human beings, according to Ruusbroec, through the likeness to God’s nature, participate in the enjoyment of God’s essence with the divine Persons. We pointed out that the union in God’s essence is the most intimate experience, but not the end-point of the mystical life as, according to our author, contemplatives are directed, again and again, to good works. Lastly, we arrived at the conclusion that Ruusbroec considers the mystical life, like the life of God, to be ceaselessly consisting of action and enjoyment. However, it is not primarily the analogy with God’s trinitarian reality of love that Ruusbroecs stresses. Basically, he accentuates the fact that mystics ceaselessly experience unification with the divine Persons, both in working and enjoying. This means that mystics, united with the divine Persons in one enjoyment on the level of God’s essence, concurrently experience that, with the divine Persons, they also “share” in God’s “flowing” and “ebbing” on the level of God’s nature. On the basis of this we have affirmed that, according to Ruusbroec, God’s activity and enjoyment in the “Divinity Itself” is God’s activity and enjoyment in the human being, and the inverse. Moreover, we have shown how the author considers both moments to occur simultaneously, both in God and in human beings, meaning that the mystical life is continuously one reality of love with God. (shrink)
A thirteenth-century manuscript attributes a short fragment of a speech Pros Basilea to the fourth-century orator Themistius. Its editors argue that the piece is authentic and was addressed to Theodosius I. In fact, style and vocabulary, geographical references, and the way the divinity of the emperor is highlighted, strongly argue against its authenticity. The fragment must be dated much later than the fourth century: this article suggests a date in the reign of Justinian.
Paideia– i.e. Greek culture, comprising, amongst other things, language, literature, philosophy and medicine – was a constituent component of the social identity of the elite of the Roman empire: as a number of influential studies on the Second Sophistic have recently shown, leading members of society presented themselves as such by their possession and deployment of cultural capital, for example by performing oratory, writing philosophy or showcasing medical interventions. As the ‘common language’ of the men ruling the various parts of (...) the empire, Greek culture became a characteristic of, and thus ade factocondition for, leading socio-political positions. Whilst most elite men would have taken for granted a good cultural education no less than a leading position, an outstanding command of the classical Greek language, literature and tradition as displayed in epideictic performances allowed some orators, philosophers and doctors to move distinctively up the social ladder, sometimes reaching the ears of, and thereby wielding influence over, the emperor himself. (shrink)
The tragic death in Tolstoy's writings has helped both Max Weber and György Lukács in characterizing the modern pathos as a tragic contemplation of the emptiness of life. Through Tolstoy's readings, Weber and Lukács found an interesting source of denying arts and modern sciences autonomy, considering, from the aesthetics sphere, the meaningless of this new immanent reality. Both has assumed Tolstoy main theme from the same perspective, contrasting ancient and modern worldviews. Max Weber presented this theme in his disenchantment of (...) world theory and Lukács, in a very similar way, following the paradox of religious needing as a mainline. -/- O tema da morte trágica, presente nos escritos de Liev Tolstói, auxiliou tanto a Max Weber como a György Lukács a caracterizarem o pathos moderno de pressentimento da morte como uma contemplação do vazio. Weber e Lukács encontraram, através das leituras de Tolstói, uma interessante maneira de questionar a autonomia da arte e da ciência moderna, considerando pela esfera estética, como se mostra sem sentido a recente realidade imanente. Ambos assumiram o tema central das obras de Tolstói segundo uma mesma imagem, derivada do contraste entre o mundo antigo e o moderno. Max Weber adequou esse tema a sua teoria do desencantamento do mundo e Lukács, de modo muito semelhante, seguindo seu conceito do paradoxo da necessidade religiosa. (shrink)
BackgroundPreprint usage is growing rapidly in the life sciences; however, questions remain on the relative quality of preprints when compared to published articles. An objective dimension of quality that is readily measurable is completeness of reporting, as transparency can improve the reader’s ability to independently interpret data and reproduce findings.MethodsIn this observational study, we initially compared independent samples of articles published in bioRxiv and in PubMed-indexed journals in 2016 using a quality of reporting questionnaire. After that, we performed paired comparisons (...) between preprints from bioRxiv to their own peer-reviewed versions in journals.ResultsPeer-reviewed articles had, on average, higher quality of reporting than preprints, although the difference was small, with absolute differences of 5.0% [95% CI 1.4, 8.6] and 4.7% [95% CI 2.4, 7.0] of reported items in the independent samples and paired sample comparison, respectively. There were larger differences favoring peer-reviewed articles in subjective ratings of how clearly titles and abstracts presented the main findings and how easy it was to locate relevant reporting information. Changes in reporting from preprints to peer-reviewed versions did not correlate with the impact factor of the publication venue or with the time lag from bioRxiv to journal publication.ConclusionsOur results suggest that, on average, publication in a peer-reviewed journal is associated with improvement in quality of reporting. They also show that quality of reporting in preprints in the life sciences is within a similar range as that of peer-reviewed articles, albeit slightly lower on average, supporting the idea that preprints should be considered valid scientific contributions. (shrink)
BackgroundHealthcare professionals and surrogate decision-makers often face the difficult decision of whether to initiate or withhold antibiotics from people with dementia who have developed a life-threatening infection after losing decisional capacity.MethodsWe conducted a vignette-based survey among 1050 Quebec stakeholders to assess their attitudes toward withholding antibiotics from people with dementia lacking decisional capacity; compare attitudes between dementia stages and stakeholder groups; and investigate other correlates of attitudes, including support for continuous deep sedation and medical assistance in dying. The vignettes feature (...) a woman moving along the dementia trajectory, who has refused in writing all life-prolonging interventions and explicitly requested that a doctor end her life when she no longer recognizes her loved ones. Two stages were considered after she had lost capacity: the advanced stage, where she likely has several more years to live, and the terminal stage, where she is close to death.ResultsSupport for withholding antibiotics ranged from 75% among seniors and caregivers at the advanced stage, to 98% among physicians at the terminal stage. Using the generalized estimating equation approach, we found stakeholder group, religiosity, and support for CDS and MAID, to be associated with attitudes toward antibiotics.ConclusionsFindings underscore the importance for healthcare professionals of discussing underlying values and treatment goals with people at an early stage of dementia and their relatives, to help them anticipate future care decisions and better prepare surrogates for their role. Findings also have implications for the scope of MAID laws, in particular in Canada where the extension of MAID to persons lacking decisional capacity is currently being considered. (shrink)
Background A team-based approach has been advocated for advance care planning in nursing homes. While nurses are often put forward to take the lead, it is not clear to what extent other professions could be involved as well. Objectives To examine to what extent engagement in advance care planning practices, knowledge and self-efficacy differ between nurses, care assistants and allied care staff in nursing homes. Design Survey study. Participants/setting The study involved a purposive sample of 14 nursing homes in Flanders, (...) Belgium. Nurses, care assistants and allied care staff completed a survey. Ethical considerations The study was approved by the University Hospital of Brussels, as part of a cluster randomized controlled trial. Results One hundred ninety-six nurses, 319 care assistants and 169 allied staff participated. After adjusting for confounders, nurses were significantly more likely than care assistants to have carried out advance care planning conversations and documented advance care planning ; differences not found between allied staff and care assistants. Advance care planning knowledge total scores differed significantly, with nurses ; 95% confidence interval 0.08–0.17; p < 0.001) and allied staff scoring higher than care assistants. We found no significant differences regarding self-efficacy. Discussion While nursing home nurses conducted more advance care planning conversations and documentation than allied care staff and care assistants, these two professional groups may be a valuable support to nurses in conducting advance care planning, if provided with additional training. Conclusions Allied care staff and care assistants, if trained appropriately, can be involved more strongly in advance care planning to enhance relational and individual autonomy of nursing home residents, alongside nurses. Future research to improve and implement advance care planning should consider this finding at the intervention development stage. (shrink)
We analyse two foundational social problems regarding early childhood education. The first, in the late nineteenth century, is infant mortality, a social problem that constituted the historical legitimation for the first crèches. The second, the prevention of school failure, is very topical today. By analysing these examples in their historicity, taking into account social, political, economical and scientific contexts, it becomes clear that early childhood education can contribute to the individualisation and decontextualisation of social problems. Yet acknowledging this also means (...) opening windows of new opportunities, as far as the construction of social problems remains an open debate in which disagreement rather than consensus is fostered. (shrink)
Lieve Van Hoof's welcome addition to the study of Plutarch's moral works focuses on a group of writings that discuss practical issues, ranging from coping with exile and curbing one's curiosity to proper nutrition and table manners. Van Hoof collectively refers to these treatises as "Plutarch's practical ethics," setting them apart from Plutarch's theoretical works, which discuss key philosophical concepts.Van Hoof begins by noting with regret the scholarly neglect of Plutarch's practical ethics. Historians of philosophy, who usually read Plutarch's (...) moral works as sourcebooks on academic philosophical theories, are frustrated when confronted with Plutarch's practical treatises, where references to academic .. (shrink)
This paper is the twin of (Duží and Jespersen, in submission), which provides a logical rule for transparent quantification into hyperprop- ositional contexts de dicto, as in: Mary believes that the Evening Star is a planet; therefore, there is a concept c such that Mary be- lieves that what c conceptualizes is a planet. Here we provide two logical rules for transparent quantification into hyperpropositional contexts de re. (As a by-product, we also offer rules for possible- world propositional contexts.) One (...) rule validates this inference: Mary believes of the Evening Star that it is a planet; therefore, there is an x such that Mary believes of x that it is a planet. The other rule validates this inference: the Evening Star is such that it is believed by Mary to be a planet; therefore, there is an x such that x is believed by Mary to be a planet. Issues unique to the de re variant include partiality and existential presupposition, sub- stitutivity of co-referential (as opposed to co-denoting or synony- mous) terms, anaphora, and active vs. passive voice. The validity of quantifying-in presupposes an extensional logic of hyperinten- sions preserving transparency and compositionality in hyperinten- sional contexts. This requires raising the bar for what qualifies as co-denotation or equivalence in extensional contexts. Our logic is Tichý’s Transparent Intensional Logic. The syntax of TIL is the typed lambda calculus; its highly expressive semantics is based on a procedural redefinition of, inter alia, functional abstraction and application. The two non-standard features we need are a hyper- intension (called Trivialization) that presents other hyperintensions and a four-place substitution function (called Sub) defined over hy- perintensions. (shrink)
_Jakob the Liar_ (1999) Director: Peter Kassovitz. Screenplay: Jurek Becker (adapted from his novel), Peter Kassovitz and Didier Decoin. Producers: Nick Gillott, Steven Haft, Robin Williams, Marsha Garces Williams. Cast: Alan Arkin, Bob Balaban, Zoltan Barabas, Michael Jeter, Liev Schreiber, Robin Williams.
Is there any way out -aside from the possibilities offered by skeptical and utilitarist thinking- to the problems which face modern science? Polo be-lieves that first it would be necessary to explain the reasons which pro-voke change in scientific models: why are the paradigms, and the views of reality which they propose, substitutable?
Given the rapid growth of participatory media content such as blogs, there is a need to design personalized recommender systems to recommend only useful content to users. We be- lieve that in addition to producing useful recommendations, certain insights from media research such as simplification and opinion diversity in recommendations should form the foundations of such recommender systems, so that the be- havior of the systems can be understood more closely, and modified if necessary. We propose and evaluate such (...) a sys- tem based on a Bayesian user-model. We use the underlying social network of blog authors and readers to model the pref- erence features for individual users. The initial results of our proposed solution are encouraging, and set the agenda for fu- ture research. Introduction. (shrink)
The dialectic of light and darkness studied in this collection of essays reveals itself as a primal factor of life as well as the essential element of the specifically human world. From its borderline position between physis and psyche, natural growth and techne, bios and ethos, it functions as the essential factor in all the sectors of life at large. We see its crucial role in all sectors of life while, prompted by man's creative imagination, it enhances and spurs his (...) vital as well as societal and spiritual life. This rare collection contains studies by Thomas Ryba, Krystina Górniak-Kocikowska, Lois Oppenheim, Sydney Feshback, Eldon van Lieve, Sitansu Ray, Theodore Litman, Peter Morgan, Colette Michael, Christopher Lalonde, L. Findlay, Christopher Eykman, Beverly Schlack Randles, Jorge García-Gómez, William Haney, Sherilyn Abdoo, David Brottman, Alan Pratt, Hans Rudnick, George Scheper, Freema Gottlieb, Marlies Kronegger. (shrink)