This article gives an overview of the moral problems experienced and described by nurses working in a dialysis unit in the Netherlands. The nurses raised a wide variety of issues that they considered were moral problems, which were grouped into seven topics. A selection of cases are described, one of which is analysed using the Nijmegen method of ethical case deliberation. This method facilitates practical approaches to the different types of moral problems encountered. The argument is made that, owing to (...) their specific moral position and responsibility, nurses' contribution to ethical reflection in ward discussions should be valued more. All caregivers involved are indispensable in developing a basis for well-reasoned decisions when deliberating about moral problems. (shrink)

While having a breast reconstruction, women have certain expectations about their future breasted bodies. The aim of this paper is to describe and analyze these expectations in the process of reconstruction. By applying a qualitative, phenomenological study within a longitudinal research design, this paper acknowledges the temporarily complex, contextualized, embodied, and subjective nature of the phenomenon of expectations. The analysis identified expectations regarding three different aspects of women’s embodiment: their gazed body, their capable/practical body, and their felt body. After reconstruction, (...) these women try to reconfigure—adjust, level or retrospectively rewrite—their expectations. Further, some women face what apparently arrives totally unexpected, namely a strange feeling breast or a failed reconstruction. The development of these women’s expectations can be understood as an active, continuously evolving, difficult and sometimes impossible dynamic of expecting the surprise that is a breast reconstruction. Within this dynamic, women formulate and reconfigure—by definition—unrealistic expectations and validate and try to achieve unexpected futures. We suggest that medical professionals can facilitate this dynamic in various ways. (shrink)

Synthetic biology is an emerging technology that asks for inclusive reflection on how people frame the field. To unravel how we can facilitate such reflection, this study evaluates the Frame Reflection Lab. Building upon playfulness design principles, the FRL comprises a workshop with video-narratives and co-creative group exercises. We studied how the FRL facilitated frame reflection by organizing workshops with various student groups. Analysis of 12 group conversations and 158 mini-exit surveys yielded patterns in first-order reflection as well as patterns (...) in second-order reflection. Also patterns in participants’ framing of synthetic biology could be induced; participants’ viewpoints converged to some extent, yet with openness to individual viewpoint differences. Although the FRL method fortified the reflection processes of participants, the narratives and the workshop’s flexible format could inhibit the reflection too. Therefore, we advise designers of future frame reflection methods to apply stronger conversational facilitation and narratives of slightly mysterious yet identifiable narrators, in case e.g. video-narratives are created and used to scaffold the reflection process. Nevertheless, we argue that the use of a playful frame reflection method like the FRL could function well as a step to precede more application-specific deliberation or decision-making on synthetic biology and as a method for the collection of contemporary citizen viewpoints plus rationales underlying these, for the further responsible development of the emerging field. (shrink)

BackgroundThe interpretation of clinical gait data in children with cerebral palsy (CP) is time-consuming, requires extensive expertise and often lacks transparency. Here we aimed to develop a set of look-up tables to support this process, linking typical gait features as present in CP to their potential underlying impairments.MethodsWe developed an initial core set of gait features and their potential underlying impairments based on biomechanical reasoning, literature and clinical experience. This core set was further specified through a Delphi process in a (...) multidisciplinary group of experts in gait analysis of children with CP and evaluated on 20 patient cases. The likelihood of the listed gait feature–impairment relationships was scored by the expert panel on a five-point scale.ResultsThe final core set included 120 relevant gait feature–impairment relations including likelihood scores. This set was presented in the form of look-up tables in both directions, i.e., sorted by gait features with potential underlying impairment, and sorted by impairments with potential related gait features. The average likelihood score for the relations was 3.5 ± 0.6 (range 2.1–4.6).ConclusionThe developed set of look-up tables linking gait features and impairments, can assist gait analysts and clinicians in standardized biomechanical reasoning, to support treatment decision-making for gait impairments in children with CP. (shrink)

This article provides an affirmative feminist reading of the philosophy of Henri Bergson by reading it through the work of Karen Barad. Adopting such a diffractive reading strategy enables feminist philosophy to move beyond discarding Bergson for his apparent phallocentrism. Feminist philosophy finds itself double bound when it critiques a philosophy for being phallocentric, because the setup of a master narrative comes into being with the critique. By negating a gender-blind or sexist philosophy, feminist philosophy only reaffirms its parameters, and (...) setting up a master narrative costs feminist philosophy its feminism. I thus propose and practice a different methodological starting point, one that capitalizes on "diffraction." This article experiments with the affirmative phase in feminist philosophy prophesied by Elizabeth Grosz, among others. Working along the lines of the diffractive method, the article at the same time proposes a new reading of Bergson (as well as of Barad), a new, different metaphysics indeed, which can be specified as onto-epistemological or "new materialist.". (shrink)

In this paper a corporate social responsibility audit is developed following the underlying methodology of the quality award/excellence models. Firstly the extent to which the quality awards already incorporate the development of social responsibility is examined by looking at the Malcolm Baldrige National Quality Award and the European Quality Award. It will be shown that the quality awards do not yet include ethical aspects in relation to social responsibility. Both a clear definition of social responsibility and an improved audit instrument (...) are required. A definition and an audit instrument are developed which stimulate movement in that direction and help organisations to reflect on their position in relation to social responsibility. (shrink)

Many political theorists, philosophers, social scientists, and other academics engage in political activism. And many think this is how things ought to be. In this essay, I challenge the ideal of the politically engaged academic. I argue that, quite to the contrary, political theorists, philosophers, and other political thinkers have a prima facie duty to refrain from political activism. This argument is based on a commonsense moral principle, a claim about the point of political thought, and findings in cognitive psychology.

In the recently published Papyrus Bodmer 30 one of the six poems deals with the story of Genesis 22. At many places the poem drastically deviates from the biblical text, and the editors of the papyrus are insufficiently aware of the background of these deviations. In this article the authors demonstrate that almost all of them have their background in a centuries long process of both Jewish and Christian reflection on this biblical chapter. It is the very specific ‘Wirkungsgeschichte’ of (...) Gen. 22 that explains most of the poem’s specifics. (shrink)

We appreciate that the theme “ethics of ethics conferences” that we introduced in 2023 (Van der Graaf et al. 2023) was echoed by the previous and current presidents of the International Association...

ABSTRACT Over the past few decades the concept of (human) dignity has deeply pervaded medical ethics. Appeals to dignity, however, are often unclear. As a result some prefer to eliminate the concept from medical ethics, whereas others try to render it useful in this context. We think that appeals to dignity in medical ethics can be clarified by considering the concept from an historical perspective. Firstly, on the basis of historical texts we propose a framework for defining the concept in (...) medical debates. The framework shows that dignity can occur in a relational, an unconditional, a subjective and a Kantian form. Interestingly, all forms relate to one concept since they have four features in common: dignity refers, in a restricted sense, to the ‘special status of human beings’; it is based on essential human characteristics; the subject of dignity should live up to it; and it is a vulnerable concept, it can be lost or violated. We argue that being explicit about the meaning of dignity will prevent dignity from becoming a conversation‐stopper in moral debate. Secondly, an historical perspective on dignity shows that it is not yet time to dispose of dignity in medical ethics. At least Kantian and relational dignity can be made useful in medical ethics. (shrink)

In this paper it will be argued that Brentano's later writings about this topic can be understood better if one describes it as a result partly of his immanent development and partly of Brentano's reactions to his contemporaries.

The label ‘Translational Research’ (TR) has become ever more popular in the biomedical domain in recent years. It is usually presented as an attempt to bridge a supposed gap between knowledge produced at the lab bench and its use at the clinical bedside. This is claimed to help society harvest the benefits of its investments in scientific research. The rhetorical as well as moral force of the label TR obscure, however, that it is actually used in very different ways. In (...) this paper, we analyse the scientific discourse on TR, with the aim to disentangle and critically evaluate the different meanings of the label. We start with a brief reconstruction of the history of the concept. Subsequently, we unravel how the label is actually used in a sample of scientific publications on TR and examine the presuppositions implied by different views of TR. We argue that it is useful to distinguish different views of TR on the basis of three dimensions, related to (1) the construction of the ‘translational gap’; (2) the model of the translational process; and (3) the cause of the perceived translational gap. We conclude that the motive to make society benefit from its investments in biomedical science may be laudable, but that it is doubtful whether the dominant views of TR will contribute to this end. (shrink)

Contextualist moral philosophers criticise hands-off liberal theories of justice for abstracting from the cultural context in which people make choices. Will Kymlicka and Joseph Carens, for example, demonstrate that these theories are disadvantageous to cultural minorities who want to pursue their own way of life. I argue that Pierre Bourdieu's critique of moral reason radicalises contextualist moral philosophy by giving it a sociological turn. In Bourdieu's view it is not enough to provide marginalised groups or subgroups with equal access to (...) public institutions and specific cultural rights—in some cases this may in fact be detrimental. He contends that scientists, politicians and other intellectuals have a duty to take seriously the social presuppositions of free deliberate choice and public opinion and to support cultural minorities with instruments to liberate themselves from their often precarious situation. (shrink)

In most Western countries, health law bioethics are strongly intertwined. This strong connection is the result of some specific factors that, in the early years of these disciplines, facilitated a rapid development of both. In this paper, I analyse these factors and construe a development theory existing of three phases, or ideal‐typical models. In the moralistic‐paternalistic model, there is almost no health law of explicit medical ethics and the little law there is is usually based on traditional morality, combined with (...) paternalist motives, the objections to this modal are that its paternalism and moralism are unacceptable, that it is too static and knows no external control mechanisms. In the liberal model, which is now dominant on most Western countries, law and ethics closely cooperate and converge, both disciplines use the same framework for analysis: they are product‐oriented rather than practice‐oriented; they use the same conceptual categories, they focus on the minimally decent rather than the ideal, and they are committed to the same substantive normative theory in which patient autonomy and patient rights are central. However, each of these four characteristics also result in a certain one‐sidedness. In some countries, a third model is emerging. In this postliberal model, health law is more modest and acknowledges its inherent and normative limits, whereas ethics takes a richer and most ambitious self image. As a result health law and ethics will partly diverge again. (shrink)

Due to the terrorist attacks of 9/11 and the anthrax letters of a few weeks later, the concept of dual use has spread widely in the life sciences during the past decade. This article is aimed at a clarification of the dual use concept and its scope of application for the life sciences. Such a clarification would greatly facilitate the work of policymakers seeking to ensure security while avoiding undesirable interventions of government in the conduct of science. The article starts (...) with an overview of the main developments in life sciences in relation to dual use. This is illustrated by discussions on synthetic biology and dual use. The findings lead to a reconsideration of the dual use concept. An area in need of further attention is to what extent threats and intentions should have impact on the definition of dual use. Possible threats are analyzed against the background of the phenomenon of securitization of health care and life sciences: considering these sectors of society in security terms. Some caveats that should be taken into account in a dual use policy are described. An acceptable, adequate and applicable definition of the dual use concept could help researchers, universities, companies and policy makers. Such a definition should build upon, but go beyond, the view developed in the influential Fink-report, which concentrates on the so-called ‘experiments of concern’, e.g. experiments that enhance the virulence of pathogens (National Research Council of the National Academies 2004) It will be argued that—in addition to these more technical aspects—a definition of dual use should include the aspect of threats and intentions. (shrink)

Recent research suggests that one can have the feeling of being the cause of an action’s outcome, even in the absence of a prior intention to act. That is, experienced self-agency over behavior increases when outcome representations are primed outside of awareness, prior to executing the action and observing the resulting outcome. Based on the notion that behavior can be represented at different levels, we propose that priming outcome representations is more likely to augment self-agency experiences when the primed representation (...) corresponds with a person’s behavior representation level. Three experiments, using different priming and self-agency tasks, both measuring and manipulating the level of behavior representation, confirmed this idea. Priming high level outcome representations enhanced experienced self-agency over behavior more strongly when behavior was represented at a higher level, rather than a lower level. Thus, priming effects on self-agency experiences critically depend on behavior representation level. (shrink)

This chapter contains sections titled: Background Concepts for Examining LTS Dynamics Societal Implications of LTS References and Further Reading.

Just War Theorists have neglected that a lack of “just military preparedness” on the side of a country seriously undermines its capability to resort justly to military force. In this paper, I put forth five principles of “just military preparedness” and show that since the new Obama administration will seek to maintain the United States’ dominant military position in the world, it will violate each of the principles. I conclude on this basis that we should anticipate that the Obama administration (...) will add another page to the United States’ history of unjust military interventions. (shrink)

Vrijheid van kunst betekent dat de maker vrij is om de kunst te maken die hij wil. Hij is degene die bepaalt wat hij maakt en hoe hij het gemaakte naar buiten brengt. Het publiek kan verschillend op de naar buiten gebrachte kunst reageren en kan eventueel de kunstenaar vragen verantwoording af te leggen. Een kunstenaar kan op dit verzoek ingaan, al hoeft dat in verreweg de meeste gevallen niet. Het afleggen van verantwoording beperkt de vrijheid van kunst echter niet. (...) Zij staat voor de dialoog die door kunstenaars zelf in bepaalde gevallen wordt gezocht, met name als het gaat om geëngageerde kunst. (shrink)

This paper attempts to liberate the concept of "spirituality" from its apolitical consumerized present, and suggests that our thinking about selves as well as about secularity and religion must recognize its debts to Orientalist practices.

The philosophical aspects of Greek medicine are now more widely appreciated, not only by historians of science and medicine but also by students of philosophy in a more narrow sense. There has also been a greater appreciation of the fact that Greek medical writers not only reflect a derivative awareness of developments in philosophy but that they also actively contributed to the formation of philosophical thought more strictly defined, for instance by developing concepts and methodologies for the acquisition of knowledge (...) and understanding. Yet the consequences of this for a renewed study of the formation of Greek philosophy have yet to be drawn; and disciplinary boundaries between historians of medicine on the one hand and philosophers and historians of philosophy on the other still pose obstacles to an integrated account of Greek thought that takes on board the contributions by the medical writers. Some preliminary remarks may therefore be in order. (shrink)

In European nations, the aging of the workforce is a major issue which is increasingly addressed both in national and organizational policies in order to sustain older workers’ employability and to encourage longer working lives. Particularly older workers’ employability can be viewed an important issue as this has the potential to motivate them for their work and change their intention to retire. Based on lifespan development theories and Van der Heijden’s ‘employability enhancement model’, this paper develops and tests an age-moderated (...) mediation model (which refers to the processes that we want to test in this model), linking older workers’ (55 years old and over) perceptions of job support for learning (organizational factor) and perceptions of negative age stereotypes on productivity (job-related factor), on the one hand, and their intention to retire, on the other hand, via their participation in employability enhancing activities, being the mediator in our model. A total of 2,082 workers aged 55 years and above were included in the analyses. Results revealed that the two proposed relationships between the predictors and intention to retire were mediated by participation in employability enhancing activities, reflecting two mechanisms through which work context affects intention to retire (namely “a gain spiral and a loss spiral”). Multi-Group SEM analyses, distinguishing between two age groups (55-60 and 61-65 years old), revealed different paths for the two distinguished groups of older workers. Employability mediated the relationship between perceptions of job support for learning and intention to retire in both age groups, whereas it only mediated the relationship between perceptions of negative age stereotypes and intention to retire in the 55-60 group. From our empirical study, we may conclude that employability is an important factor in the light of older workers’ intention to retire. In order to motivate this category of workers to participate in employability enhancing activities and to work longer, negative age stereotypes need to be combated. In addition, creating job support for learning over the lifespan is also an important HR practice to be implemented in nowadays’ working life. (shrink)

The International Committee of Medical Journal Editors is a working group of editors of selected medical journals that meets annually. Founded in Vancouver, Canada, in 1978, it currently consists of 11 member journals and a representative of the US National Library of Medicine. The major purpose of the Committee is to address and provide guidance for the conduct and publishing of biomedical research and the ethical tenets underpinning these activities. This advice is detailed in the Committee's Uniform Requirements for Manuscripts (...) Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication . Recently, the ICMJE has adopted an interventionist role to ensure transparency of conflict of interest revelations in the conduct and publication of industry supported research. It also pursues a policy for the lodgement with trial registries of specified details of Phase III clinical trials. Failure to comply would jeopardise publication of trial outcomes in ICMJE member journals. This policy has resulted in the coming on stream of trial registries, international agreement on trial minimal datasets and compliance with trial registration requirements. (shrink)

In most Western countries, health law bioethics are strongly intertwined. This strong connection is the result of some specific factors that, in the early years of these disciplines, facilitated a rapid development of both. In this paper, I analyse these factors and construe a development theory existing of three phases, or ideal‐typical models. In the moralistic‐paternalistic model, there is almost no health law of explicit medical ethics and the little law there is is usually based on traditional morality, combined with (...) paternalist motives, the objections to this modal are that its paternalism and moralism are unacceptable, that it is too static and knows no external control mechanisms. In the liberal model, which is now dominant on most Western countries, law and ethics closely cooperate and converge, both disciplines use the same framework for analysis: they are product‐oriented rather than practice‐oriented; they use the same conceptual categories, they focus on the minimally decent rather than the ideal, and they are committed to the same substantive normative theory in which patient autonomy and patient rights are central. However, each of these four characteristics also result in a certain one‐sidedness. In some countries, a third model is emerging. In this postliberal model, health law is more modest and acknowledges its inherent and normative limits, whereas ethics takes a richer and most ambitious self image. As a result health law and ethics will partly diverge again. (shrink)

In this article, I argue that law has two oftenneglected functions: the expressive and thecommunicative functions. They are especially importantfor legislation on moral issues, such as biomedicalethics and anti-discrimination law. The communicativefunction of law is a complex one: law may create anormative framework, a vocabulary to structurenormative discussions, as well as institutions andprocedures that promote further discussion. Theexpressive function of law is at stake when itexpresses which fundamental standards, which valuesare regarded as important. The recognition of thesefunctions is not only (...) important for descriptivepurposes; it is also fruitful for normative theory. (shrink)

Theoretical models for physician-patient communication in clinical practice are described in literature, but none of them seems adequate for solving the communication problem in clinical practice that emerges in case of factitious disorder. Theoretical models generally imply open communication and respect for the autonomy of the patient. In factitious disorder, the physician is confronted by lies and (self)destructive behaviour of the patient, who in one way or another tries to involve the physician in this behaviour. It is no longer controversial (...) that the physician should communicate his consideration of a factitious disorder without insistence that the patient accepts this diagnosis. However, the balance between patient autonomy and open communication on the one hand, and the preservation of the patient's health, physician integrity and of a constructive physician-patient relationship on the other is easily disrupted. In this article, an epistemological model is described to facilitate a positive outcome of confrontation in treatment of factitious disorder. Analysing the problem in terms of systems theory will help the physician to assess what information is appropriate to use in which phase of the patient's treatment, while preserving the physician-patient relationship. (shrink)