This paper compares the ethical decisions and attitudes of business students and practitioners. Recent unpublished data from a national study of over 1600 students are contrasted with information reported previously. Students are found consistently to make less ethical choices than practitioners, and there is some indication that students are making less ethical choices in the 1980s than in the 1960s. In addition, both students and practitioners agree that buyers should beware, view the role of business more narrowly, and find fewer (...) incentives to behave ethically over time. Codes of ethics appear to be less influential than the individual's strong personal value system and one's superiors behaving ethically; support for codes is declining. The paper concludes with observations about the limitations and possibilities for survey research in this area drawing on other studies that used the same instrument utilized for this paper. Some implications for future research are suggested. (shrink)

The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry. Why are the rates of psychiatric comorbidity so high and what are their implications for the ontological and epistemological status of comorbid psychiatric diseases? Current explanations focus either on classification choices or on causal ties between disorders. Based on empirical and philosophical arguments, we propose a conventionalist interpretation of psychiatric comorbidity instead. We argue that a conventionalist approach fits well with research and clinical practice and resolves (...) two problems for psychiatric diseases: experimenter’s regress and arbitrariness. (shrink)

This paper compares the ethical decisions and attitudes of business students and practitioners. Recent unpublished data from a national study of over 1600 students are contrasted with information reported previously. Students are found consistently to make less ethical choices than practitioners, and there is some indication that students are making less ethical choices in the 1980s than in the 1960s. In addition, both students and practitioners agree that buyers should beware, view the role of business more narrowly, and find fewer (...) incentives to behave ethically over time. Codes of ethics appear to be less influential than the individual''s strong personal value system and one''s superiors behaving ethically; support for codes is declining. The paper concludes with observations about the limitations and possibilities for survey research in this area drawing on other studies that used the same instrument utilized for this paper. Some implications for future research are suggested. (shrink)

In psychiatry, many scientists desire to move from a classification system based on symptoms toward a system based on biological causes. The idea is that psychiatric diseases should be redefined such that each disease would be associated with specific biological causes. This desire is intelligible because causal disease models often facilitate understanding and identification of new ways to intervene in disease processes. In its attempt to move from syndromal to specific etiological definitions, psychiatry follows the trend of general medicine.Current psychiatric...

No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

At the beginning of 2020, COVID-19 became a global problem. Despite all the efforts to emphasize the relevance of preventive measures, not everyone adhered to them. Thus, learning more about the characteristics determining attitudinal and behavioral responses to the pandemic is crucial to improving future interventions. In this study, we applied machine learning on the multi-national data collected by the International Collaboration on the Social and Moral Psychology of COVID-19 (N = 51,404) to test the predictive efficacy of constructs from (...) social, moral, cognitive, and personality psychology, as well as socio-demographic factors, in the attitudinal and behavioral responses to the pandemic. The results point to several valuable insights. Internalized moral identity provided the most consistent predictive contribution—individuals perceiving moral traits as central to their self-concept reported higher adherence to preventive measures. Similar was found for morality as cooperation, symbolized moral identity, self-control, open-mindedness, collective narcissism, while the inverse relationship was evident for the endorsement of conspiracy theories. However, we also found a non-negligible variability in the explained variance and predictive contributions with respect to macro-level factors such as the pandemic stage or cultural region. Overall, the results underscore the importance of morality-related and contextual factors in understanding adherence to public health recommendations during the pandemic. (shrink)

This book provides an introduction to postphenomenology, an emerging school of thought in the philosophy of technology and science and technology studies, which addresses the relationships users develop with the devices they use.

Cette étude analyse la pensée actuelle sur les décisions-fin-de-vie (DfdV) en France d’un point de vue hollandais. Un nombre limité d’interviews avec des ‘opinion-leaders’ français est pris comme base du project. Jusqu’au jour présent, le domaine des DfdV en France a été troublé en l’absence de définitions et de législation plus spécifiques. Les médecins français pourront faire face à un dilemme en soignant un malade mourant, pris en étau entre le caractère illégal officiel de l’euthanasie d’une part et l’obligation professionnelle (...) de traiter chaque cas de façon particulière d’autre part. La conséquence de l’environnement réglementaire incertain est une déresponsabilisation des médecins français vis-à-vis de leurs collègues et des patients. L’adoption de réformes législatives, en ayant la possibilité d’augmenter le nombre de cas d’euthanasie, se heurtait en France à des arguments cartésiens, paternalistes et religieux. En Novembre 2004, l’Assemblée Nationale a adopté une proposition de loi ayant pour but de rendre plus transparente la mise en pratique des limitations et des arrêts de traitement et de reduire la crainte des médecins de poursuites pénales. Cette proposition de loi a été par la suite approuvée par le Sénat. Aux Pays-Bas, l’euthanasie–la terminaison active de la vie–est légale et régulée par des critères précis. L’approche hollandaise fait référence au concept anglo-saxon d’autonomie du patient et correspond à la préférence générale de la société hollandaise pour la révélation et la régulation des activités controversielles plutôt que de tolérer leur existence sub rosa. Depuis l’entrée en vigueur de la régulation sur l’euthanasie aux Pays-Bas le nombre de cas rapportés a augmenté, mais pas le nombre d’euthanasies. Les règles sont respectées et la qualité de la communication entre médecin et patient est élevée. La vigilance Française pour l’autonomie professionnelle offre un exemple de valeur pour les Hollandais. Les Hollandais, de leur part, fournissent des exemples concrets pour la régulation du domaine des DfdV en France dont on a fait un début récemment. (shrink)

The clinical introduction of medical devices often occurs with relatively little oversight, regulation and (long-term) follow-up. Some recent controversies underscore the weaknesses of the current regime, such as the complications surrounding the metal-on-metal hip implants and the scandal surrounding the global breast implant scare of silicone implants made by France's Poly Implant Prothese (PIP) Company. The absence of national registries hampered the collection of reliable information on the risks and harms of the PIP breast implants. To warrant long-term safety, a (...) case can be made for mandatory post-marketing surveillance by means of the establishment of compulsory registries. In this edition of Public Health Ethics, Schofield calls for debate on how such a registry system should be initiated and maintained and how it would relate to the ethical requirement of consent. Here we use breast implant registries as a case to discuss whether and when a so-called ‘thick opt-out’ would be an appropriate method to include people in medical device registries. We conclude that a thick opt-out procedure for medical device registries is only justifiable in cases where inclusion does not involve burdens (or very low), when it does not involve a sensitive subject and when the data are stored anonymously (or at least not directly linked to the medical record). Otherwise, inclusion should be sought by means of an opt-in. (shrink)

Research has shown the importance of engaging in networking behaviors for employees’ career success. Networking behaviors can be seen as a proactive way of creating access to career-related social resources and we argue that this type of proactive career behaviors might be particularly relevant for freelancers who cannot depend on an organizational career system supporting their further development, yet whose careers are characterized by high levels of uncertainty and unpredictability. To date, however, our understanding of how freelancers, being a category (...) of workers that are deprived of an organizational context of support for career development, can safeguard their employability, is limited. Therefore, this study addresses this gap and investigates whether freelancers’ networking behaviors are positively associated with career outcomes, through the mediating role of the need for relatedness fulfillment and employability-enhancing competencies. Hypotheses are tested via Structural Equation Modelling using a sample of 1,874 freelancers from Belgium, France, Germany, the Netherlands and the United Kingdom. The results generally support our hypotheses, providing evidence for a significant association between networking behaviors and need for relatedness fulfillment, and between networking behaviors and employability-enhancing competencies. Moreover, we found a significant association between need for relatedness fulfillment and employability-enhancing competencies, being the mediators in our research model and the outcomes of career satisfaction and future career opportunities. Implications for career development in the contemporary workplace are discussed, with particular attention for need for relatedness fulfillment, employability, and sustainable careers of freelance workers. (shrink)

This article contains a critical survey of the attempts that have been made to writea comprehensive history of philosophy in the Netherlands. Three historiographical typescan be distinguished. In the early nineteenth century, after the founding of the Kingdom of the Netherlands, Dutch philosophers became increasingly aware of the peculiaritiesof their national tradition in philosophy — as distinct from the traditions of France, Germany or Britain. The result was what might be called a 'patriotic historiography', which tended to glorify the Dutch (...) intellectual past. In the second half of the century, however, a 'critical historiography' emerged, which tended to stress what was taken to be the lack of originality and relative unimportance of the Dutch contribution to philosophy. This negative selfimage of Dutch philosophy remained dominant until the advent of the influential historian of philosophy Ferdinand Sassen. Sassen, in 1959, managed topresent a more balanced account, based on careful and detailed research, of the historyof philosophical thought in the Netherlands. Nevertheless, his 'synthetic historiography' leaves a number of important questions unanswered. In recent years, research has tended to concentrate on bringing out the unique intermediary position of the Netherlands,which on many occasions has enabled it to play an influential role in various philosophical developments throughout Europe. Looked at from this angle, the study of Dutch Platonism, humanism, Cartesianism, Spinozism, Leibnizianism, Newtonianism, Kantianism, Hegelianism, positivism etc., can provide essential contributions to the understanding of the general development of European philosophy. It is also to be hoped that knowledge oftheir national past will help contemporary Dutch philosophers to define more adequatelytheir present and future role in philosophy, within a European community which is becoming increasingly integrated. (shrink)

Opponents of women's education assumed that women were less naturally gifted than men, that education was inappropriate for Christian women, or that it was irrational to educate women because they could not fulfil the civil and ecclesiastical offices for which education was the required preparation. Van Schurman argued against all three assumptions in her Dissertatio . She presented her arguments as syllogisms, which she based on the authority of the Bible, on the Christian churches' understanding of human nature, and on (...) the necessity of knowledge to acquire virtues and to avoid falling into heresy. Van Schurman concluded that education was appropriate for women, in general, for exactly the same reasons as it was appropriate for men. Les opposants à une éducation des femmes considéraient qu'elles étaient naturellement moins douées que les hommes, que l'éducation était quelque chose d'inapproprié pour les femmes chrétiennes, ou qu'il était irrationnel d'éduquer les femmes car elles ne remplissent aucune charges civile ou ecclé siastique, charges pour lesquelles l'éducation constituait une préparation requise. Van Schurman discute ces trois assertions dans sa Dissertatio . Elle présente ses arguments comme des syllogismes, qu'elle fonde sur l'autorité de la Bible, sur la compréhension de la nature humaine par les églises chrétiennes, et sur la nécessité de la connaissance pour acquérir de la vertu et pour éviter de tomber dans l'hérésie. Van Schurman conclut qu'il est approprié que les femmes en général soient éduquées, tout comme cela est approprié pour les hommes. (shrink)

A adoção de um catálogo constitucional de direitos e o fortalecimento do judicial review, trouxeram como consequência a judicialização da política em inúmeras democracias, onde se verifica uma expansão da atuação do Poder Judiciário em detrimento das esferas representativas do Estado. Neste contexto, tem se observado em países do Sul Global, o emprego de novos mecanismos procedimentais em casos que envolvem a violação contínua e generalizada de direitos fundamentais, de alguns grupos menos favorecidos, decorrente de bloqueios políticos e institucionais, denominados (...) de “litígios estruturais”. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 99 the movement of the Dutch to France. Only in the second half of the century, as DutchFrench relations deteriorated, and Protestantism was actively persecuted, did Dutch students turn away from France. Professor Dibon reveals the kinds of untapped source materials that exist for tracing these student voyages, for assessing the intellectual conditions in France, and for tracing the course of ideas. Items found ill funeral orations, (...) guide books, letters, unpublished student travel diaries, various Album amicorum that students carried with them, university records, applications of students for funds, etc., provide the basis for Professor Dibon's sketch of where Dutch students went, how they were received in Paris and elsewhere, whom they met, what universities they attended, and how long they spent at various stages of their tours. Professor Dibon clearly shows that there is a rich mine of information to be found through careful, painstaking research in these many manuscripts or rare printed sources. The picture he presents of the travels of Gronovius' brother-in-law, Samuel Ten Nuyl, later professor of history and eloquence at the University of Nijmegen, indicates the valuable materials that can be unearthed from such labors. Ten Nuyl was in and around Paris from 1659-1661. Letters of Introduction from Gronovius, Heinsius, and Van Schooten led to his being accepted in the highest Protestant and Catholic intellectual circles, got him into the Royal Library (t), and into the circles of Pierre-Daniel Huet, Mfinage, DailI~, Guy Patin, Chapelain, and many others. A study of these Dutch voyagers throws much light on the milieu at certain university centers, such as Caen and Orleans, on the possible exchanges and interchanges of ideas, and on the careers of some of the major figures in the Dutch universities. Professor Dibon has performed a most valuable service in this superbly written and documented study in pointing to an area of research that can aid us greatly in understanding the actual intellectual currents and cross-currents of the seventeenth century. His concluding paragraph (pp. 34-35) sums up what we can learn from such data. Ainsi nous pouvons esp6rer voir naitre de la convergence de multiples d6tails recueillis dans les journaux, dans les albums amicorum, les registres universitaires et autres documents d'archives une ~tude d'ensemble du Voyage en France des ~tudiants n6erlandais au XVIIe sidle. Une telle ~tude, fond~e sur une connaissance, qui serait ~t ~largir et h preciser, des milieux universitaires et des cercles ~rudits de la France du XVIIe sidle, nourrie de la substance de rant de correspondances en grande partie in6dites, constituerait h coup stir le chapitre le plus attachant d'une histoire des relations culturelles franco-nberlandaises. Elle ne manquerait pas par surcrolt de faire apparaitre en pleine lumi~re ce fait trop souvent m6connu que les relations culturelles en ce temps restaient, en d~pit des conflits politiques ou des rivalit& ~conomiques, au sein m~me des pol~miques religieuses, des &hanges de personne ~t personne. I1 faut se bien convaincre que c'est dans une tr6s large mesure /~ partir de tels 6changes,--. (shrink)

Stephen Stich has argued that psychological theories that instantiate his Syntactic Theory of Mind are to be preferred to content-based or representationalist theories, because the former can capture and explain a wider range of generalizations about cognitive processes than the latter. Stich's claims about the relative merits of the Syntactic Theory of Mind are unfounded. Not only is it false that syntactic theories can capture psychological generalizations that content-based theories cannot, but a large class of behavioral regularities, readily explained by (...) content-based theories, appear to be beyond their explanatory reach. (shrink)

How do we measure happiness? Focusing on subjective measures as a proxy for welfare and well-being, this book finds ways to do that. Subjective measures have been used by psychologists, sociologists, political scientists, and, more recently, economists to answer a variety of scientifically and politically relevant questions. Van Praag, a pioneer in this field since 1971, and Ferrer-i-Carbonell present in this book a generally applicable methodology for the analysis of subjective satisfaction. Drawing on a range of surveys on people's satisfaction (...) with their jobs, income, housing, marriages, and government policy, among other areas of life, this book shows how satisfaction with life "as a whole" is an aggregate of these domain satisfactions. Using German, British, Dutch, and Russian data, the authors cover a wide range of topics. This groundbreaking book presents a new and fruitful methodology that constitutes a welcome addition to the social sciences. The paperback edition has been revised to bring the literature review up-to-date and the chapter on poverty has been revised and extended to take account of new research. (shrink)

The Gesta Normannorum Ducum is one of the most important sources for the history of Normandy and England in the eleventh and twelfth centuries, and contains the earliest prose account of the Norman Conquest. It was written by a succession of authors, the first of whom was William of Jumieges, who wrote for William the Conqueror. Later historians, such as Orderic Vitalis and Robert of Torigni, interpolated and extended the chronicle as far as King Henry I. The later accretions reveal (...) much not only about changing attitudes towards the Norman invasion of England, but also about views of the early Viking foundations of Normandy.Elisabeth van Houts's two-volume edition is based on a study of all forty-seven extant manuscripts of the Gesta, including the earliest surviving copy of c. 1100, unknown until very recently. The full original text of William of Jumieges is supplied, as well as the integral text of the subsequent revisions and additions. Volume I contains Dr van Houts's introduction to the whole work, together with the text and translation of books i-iv. Volume II contains books v-viii. The edition forms an important contribution to our understanding of Anglo-Norman politics. (shrink)

Teaching competency in bioethics has been a concern of the field since its start. In 1976, The Hastings Center published the first report on the teaching of contemporary bioethics. Graduate programs culminating in an MA or PhD were not needed at the time, concluded the report. “In the future, however,” the report speculated, “the development and/or changing social priorities may at some point allow, or even require, the creation of new academic structures for graduate education in bioethics.” Although that future (...) might be upon us, the creation of a terminal degree in bioethics has its detractors. Scholars have debated whether bioethics is a discipline with its own methods and theoretical grounding, a multidisciplinary field bringing various professional perspectives to bear on particular types of problems, a set of problem-solving skills to resolve moral disagreements, or something else entirely. Whether or not efforts to develop the methods and theory of bioethics have matured to the point that it is now a discipline in the strictest sense, new bioethics training programs have appeared at all postsecondary levels. In this essay, we examine the number and types of U.S. programs and degrees in this growing field. (shrink)

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

Two experiments are reported that evaluated survey learning of youth with DS and typically developing children (TD) matched on Mental Age (MA). In Experiment 1, the experimenter navigated participants through a novel virtual environment along a circuitous path, beginning and ending at a target landmark (i.e., a door). Then, the participants were placed at a pre-specified location in the environment and instructed to navigate to the same door using the shortest possible path from their current location. They completed the task (...) three times: once after being shown the environment one time, once after three exposures, and once after five exposures. Results indicated that the participants with DS exhibited significantly less skill at identifying the shortcut than did the TD participants. In Experiment 2, participants learned two overlapping routes through a simple environment. Following acquisition, they were tested on several measures of survey knowledge: finding a shortcut, identifying the direction of landmarks not currently visible from their location in the environment, and recognizing a bird’s-eye representation of the overall environment. The results of Experiment2 indicated that the participants with DS were at least as good as the TD participants on all of our measures of survey learning. Hence, we concluded that people with DS can acquire some survey knowledge when they learn a simple environment. However, the performance of both groups was relatively poor in Experiment 2, indicating a need to consider identifying the mechanisms underlying the poor performance on wayfinding of people with DS. Identifying the underlying mechanisms, is a logical first step in devising methods of enhancing environmental learning of people with DS. (shrink)

There are growing concerns that increased screen device usage may have a detrimental impact on classroom behaviour and attentional focus. The consequences of screen use on child cognitive functioning have been relatively under-studied, and results remain largely inconsistent. Screen usage may displace the time usually spent asleep. The aim of this study was to examine associations between screen use, behavioural inattention and sustained attention control, and the potential modifying role of sleep. The relations between screen use, behavioural inattention, sustained attention (...) and sleep were investigated in 162 6- to 8-year-old children, using parent-reported daily screen use, the SWAN ADHD behaviour rating scale, The sustained attention to response task and the children’s sleep habits questionnaire. Tablet use was associated with better sustained attention performance but was not associated with classroom behavioural inattention. Shorter sleep duration was associated with poorer behavioural inattention and sustained attention. Sleep quality and duration did not act as mediators between screen usage and behavioural inattention nor sustained attention control. These findings suggest that careful management of the amount of time spent on electronic screen devices could have a beneficial cognitive impact on young children. The results also highlight the critical role of sleep in enhancing both behavioural attention and sustained attention, which are essential for supporting cognitive development and learning. (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 our society, where interest in Buddhist meditation is expanding enormously, numerous scientific studies are now conducted on the neurophysiological effects of meditation practices and on the neural correlates of meditative states. However, very few studies have been conducted on the experience associated with contemplative practice: what it is like to meditate -- from moment to moment, at different stages of practice -- remains almost invisible in contemporary contemplative science. Recently, 'micro-phenomenological' interview methods have been developed to help us become (...) aware of lived experience and describe it with rigour and precision. The present article presents the results of a pilot project1 aimed at applying these methods to the description of meditative experience. The first part of the article describes these methods and their adjustment for the investigation of meditative experience. The second part provides micro- phenomenological descriptions of two processes of which meditation practice enables the practitioner to become aware: the process of losing contact with the current situation and generation of virtual ones in 'mind-wandering' episodes, and the process of emergence of a thought. The third part of the article highlights the interest such descriptions may have for practitioners and for teachers of meditation, defines the status of these results, and outlines directions for further research. (shrink)

Chervenak and McCullough, authors of the most acknowledged ethical framework for maternal–fetal surgery, rely on the ‘ethical–obstetrical’ concept of the fetus as a patient in order to determine what is morally owed to fetuses by both physicians and the women who gestate them in the context of prenatal surgery. In this article, we reconstruct the argumentative structure of their framework and present an internal criticism. First, we analyse the justificatory arguments put forward by the authors regarding the moral status of (...) the fetus qua patient. Second, we discuss the internal coherence and consistency of the moral obligations those authors derive from that concept. We claim that some of the dilemmas their approach is purported to avoid, such as the debate about the independent moral status of the fetus, and the foundation of the moral obligations of pregnant women (towards the fetuses they gestate) are not, all things considered, avoided. Chervenak and McCullough construct the obligations of physicians as obligations towards entities with equal moral status. But, at the same time, they assume that the woman has an independent moral status while the moral status of the fetus is dependent on the decision of the woman to present it to a physician for care. According to the logic of their own argumentation, Chervenak and McCullough implicitly admit a different moral status of the woman and the fetus, which will lead to different ascription of duties of the physician than those they ascribed. (shrink)

This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception about the nature of clinical research and the status of research subjects. Second, given that it is not clear who the research subject/s in MFS is/are, if clinical equipoise is to be used as a (...) criterion to test the ethical appropriateness of RCT, its meaning should be unambiguous. Third, because of the multidisciplinary character of MFS, it is not clear who should be in equipoise. As a result, we lack an adequate criterion for the ethical review of MFS protocols. In our account, which is based on Chervenak and McCullough's seminal work in the field of obstetric ethics, equipoise is abandoned. and RCT involving MFS can be ethically initiated when a multidisciplinary ethics review board (ERB), having an evidence-based assessment of the risks involved, is convinced that the value of answering the research hypothesis, for the sake of the health interests of future pregnant women carrying fetuses with certain congenital birth defects, justifies the actual risks research participants might suffer within a set limit of low/manageable. (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)

In many countries patient involvement is high on the healthcare policy agenda, which includes patient representation in collective decision-making. Patient organizations are generally considered to be important representatives of patients. Other actors also claim to represent patients in decision-making, such as politicians, healthcare professionals, and client advisory councils. In this paper we take a broad view of patient representation, examining all the actors claiming to represent patients in the Dutch debate on the decentralization of care. We conclude that variety in (...) forms of representation could help do justice to the variety of patient preferences. In addition we conclude that in order to ensure the democratic quality of patient representation, actors making representative claims have to reflect on how their claims relate to each other and how they can ensure authorization and accountability in the representative relationship with those they claim to represent. (shrink)

In this article, after arguing that present approaches to improving problem-solving discussions for various reasons are not satisfactory, I turn to the pragma-dialectic approach to argumentative discourse to derive a normative framework that can serve as a point of departure to enhance the quality of problem-solving discussions. I then show how this approach can be used as analytical and evaluative instrument that can help the analyst to establish whether participants in actual practice act in a fashion that is in accord (...) with the norms posited. Two real-life problem-solving discussions provide the material for this demonstration. (shrink)

OBJECTIVES: Cognitive and sensory difficulties frequently jeopardize informed consent of frail elderly patients This study is the first to test whether preliminary research experience could enhance geriatric patients' capacity to consent. DESIGN/SETTING: A step-wise consent procedure was introduced in a study on fluid balance in geriatric patients. Eligible patients providing verbal consent participated in a try-out of a week, during which bioelectrical impedance and weight measurements were performed daily. Afterwards, written informed consent was requested. Comprehension, risk and inconvenience scores (ranges: (...) 0-10) were obtained before and after the try-out by asking ten questions about the study's essentials and by asking for a risk and inconvenience assessment on a ten-points rating scale. SUBJECTS AND RESULTS: Seventy of the 78 eligible subjects started the try-out and 53 (68%) provided written consent. The comprehension score increased from 5.0 (+/- 2.3) to 7.0 (+/- 1.9) following the try-out (P < 0.001). The number of subjects capable of weighing risks and inconveniences increased from 32 to 48 (P < 0.001). CONCLUSIONS: Research experience improved the capacity to consent, still enabling an acceptable participation rate. Therefore, experienced consent seems a promising tool to optimize informed consent in frail elderly subjects. (shrink)