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)

Le présent livre est audacieux et marque, à n’en pas douter, une avancée pour les recherches sur la pensée de Damascius. Tiré de la thèse de doctorat de l’auteur, le livre interroge le concept de causalité comme procession dans le Traité des premiers principes (De principiis) de Damascius. Pelin entend se distancier de ce qu’il estime être une tendance dominante des études damascéennes (p. 32-33) : plutôt que de lire le De principiis dans une perspective épistémologique et d’y voir une (...) enquêt... (shrink)

Creatively operationalizing Claude Lévi-Strauss’ predicament that food is good to think with, I initiate a methodological conceptualization of food by exploring the ways in which it is apt to study Sri Lankan domestic and collective village life. Food is approached as an assemblage that is an emergent resultant of heterogeneous aspects with which it is deeply entangled and by way of which it turns into a potent agent shaping life. More specifically, I explore the vibrancy of these different components that (...) co-create the overall soundscape of food that as such becomes the conductor of Sri Lankan life. Food shapes domestic life by way of its preparation and consumption, and through its cultivation also conducts the collective rhythms at the village level. The conceptualization of food as an assemblage seeks to develop it as a methodology that opens up for a holistic integration and interdisciplinary collaboration. (shrink)

This paper draws on an in-depth phenomenological analysis of some interviews taken from volunteers, inviting them to reflect on their lived experiences of meaningfulness in the context of volunteering and citizenship. It is found that while some testimonies reinforce the standard conceptions of meaningfulness, other testimonies vary from it. The main challenge of this contribution consists in phenomenologically describing this alternative picture of meaningfulness, depicted as the event of witnessing. In a final part, the authors consider how volunteering is at (...) times especially prone to further experiences of witnessing. (shrink)

The credit policy of the«Communal Bank» is based on objective criteria in order to respect local autonomy. The financial results of the consolidation are difficult to determine. Several factors could have influenced the present state of municipal finances : the consolidation being done in a period of economic difficulties, the crisis of the public finances, the reform of the Municipal Fund, and the transformation of the Centers for Public Assistance into Public Centers for Social Welf are. The consolidations did not (...) generale any savings, but it al,so did not cause an alarming increase of expenses. With respect to budget balancing, the amalgamated municipalities should do better than the non-amalgamated municipalities. To keep the increase of expenses low in comparison with the revenues, the municipalities had to make cuts in several sectors.As to the current fniancial situation in the three regions, the municipalities of the Brussels regon are in a very painful situation ; in Flanders, the number of municipalities with deficits is higher than in Wallonia, but the deficits in W allonia are bigger. To stop this negative evolution one must strive for balanced budgets and reshape them into reliable instruments. (shrink)

Raphaël Van Daele L’expression chinoise ziran 自然 s’entend aussi bien à propos de la « nature », cette région de l’être dont l’émergence et les processus ne relèvent pas de la volonté ou de l’action humaine, qu’à propos d’un certain type d’agir humain. Le geste expert de l’artiste est l’exemple privilégié d’un tel agir. Loin de nuire à la cohérence de cette notion, le fait que celle-ci soit mobilisée dans le discours théorique sur l’art autant que dans le discours sur (...) la nature témoigne d’un lien organique qui, dans la pensée chinoise, unit différents domaines de la réflexion. Le présent article propose d’esquisser une lecture philosophique de la notion de ziran. Pour ce faire, nous explorerons le rôle joué par ziran dans l’oeuvre esthétique de Cai Yong 蔡邕 (133-192) et dans la pensée de Guo Xiang 郭象 († 312). (shrink)

In this comment on Johan Von Essen’s contribution on the meaning of volunteering we make some remarks about Von Essen’s starting point, which reveals a particular perspective on meaningfulness, namely that people perceive reality as meaningful when their actions and the things they encounter are part of a meaningful whole. By introducing another perspective on meaningfulness, namely that the shattering of a meaningful whole is full of meaning, we question if practices of volunteering which occur in face-to-face situations—and thus outside (...) the public realm—can be fully captured by the five predicates that make up the phenomenological structure of volunteering. (shrink)

Food and life are intimately entangled. To grasp the underlying complexity of this seemingly simple statement, this article first introduces the approach to food/eating as an assemblage enacted by various heterogeneous components, and further develops it by engaging with actor network theory and material semiotics. Thereafter the focus turns to ‘entanglement’, as inspired by quantum physics, to elicit the basic dynamics of the entanglement of food and more-than-human beings, conceived of as involving mutual and differential becomings within and among assemblages. (...) The article illustrates these entangled becomings by drawing upon examples from Sri Lanka, which in an intercultural philosophical fashion serve to establish an articulation (in the sense of a connection) between the proposed abstract approach to food and some basic premises of Buddhism and Ayurveda, a South Asian health system. Overall, the article crafts a conceptual toolbox and performs ontological groundwork wherein food and human beings as entangled assemblages provide a productive, refined, and sensitive research apparatus for the intimate study of more-than-human life and organization while also spurring novel theorizations through food/eating. (shrink)

The essay describes with great clarity the situation of publishing in the XVI-XVII Centuries, focussing on several important examples of Flemish books.

The review of Prof. Bywater′s new edition of the Poetics once more raised the question of the interpretation of dfuipria in Aristotle′s definition of the tragic hero.

Richard Taylor was born in Charlotte, Michigan on 5 November 1919. He received his A. B. from the University of illinois in 1941, his M. A. from Oberlin College in 1947, and his Ph. D. from Brown University in 1951. He has been William H. P. Faunce Professor of Philosophy at Brown University, Professor of Philosophy (Graduate Faculties) at Columbia University, and Professor of Philosophy at the University of Rochester. He is the author of about fifty articles and of five (...) philosophical books. This volume consists of essays presented to Richard Taylor on the occa sion of his sixtieth birthday. Some of the contributors have been Taylor'S students; some have been his colleagues; and all have been, and continue to be, his admirers. I have made several attempts to articulate what it is I (I would not presume to speak for anyone else) admire about Richard Taylor: (1) There is a particular 'flavor' to Taylor's philosophical writing and con versation that is wholly delightful. Like any other flavor, it can be tasted and enjoyed and remembered but never adequately described. (If there should be someone who has picked up this book who does not know what I mean, I recommend that he read the chapter on 'God' in Taylor's Metaphysics. ) (2) Taylor is a masterful dialectician. (shrink)

Les décisions politiques sur les risques environnementaux complexes font fréquemment intervenir des éléments scientifiques contestés. Il n’y a généralement pas de « faits » qui conduisent à une politique correcte unique. Les éléments de preuve qui sont intégrés dans les avis scientifiques destinés à une décision politique nécessitent une évaluation de leur qualité. En 2003, l’Agence néerlandaise d’évaluation environnementale a adopté une méthode standardisée, désignée sous le nom de « guide », dans le cadre de laquelle les principaux aspects de (...) la production et de l’utilisation des connaissances sont présentés grâce à une liste de contrôle visant à l’évaluation et à la communication des incertitudes. Dans cet article, nous présentons des résultats de l’application de ce guide à la controverse sur les risques des particules en suspension. La délibération active sur l’incertitude dans un contexte d’expertise entraîne un processus d’apprentissage commun entre les experts et les décideurs politiques, ce qui conduit à une meilleure prise de conscience du phénomène d’incertitude et de ses implications politiques.Policy decisions on complex environmental risks often involve disputed science. Typically, there are no “ facts” to support a single unequivocally correct policy. The evidence provided in scientific studies for policy-making decisions requires high-quality assessment. In 2003, the Netherlands Environmental Assessment Agency adopted a standardized method, referred to as “guidelines”, whereby key quality aspects of knowledge production and use are presented in the form of a checklist for uncertainty assessments and communication. In this article, we present the outcomes of applying the guidelines in controversies on the risks of ambient particulate matter. In the policy–advisory context, active deliberation on uncertainty produces a common learning process for advisors and policy makers, which leads to a deeper understanding and increased awareness of the phenomenon of uncertainty and its policy implications. (shrink)

Stuart Hameroff opens with an extended and updated exposition of the Penrose/Hameroff Orch-OR model, and subsequently addresses recent criticisms of quantum approaches to the brain. Evan Walker presents his view on consciousness from the perspective of a new approach to the integration of quantum theory and relativity. Friedrich Beck elaborates on the Beck/Eccles quantum approach to consciousness. Karl Pribram puts the holographic view on consciousness in perspective of his life long work. Peter Marcer and Edgar Mitchell explain the relevance of (...) quantum holography for consciousness. Gordon Globus discusses the relation between postmodern philosophical theories and quantum consciousness. Chris Clarke develops a theory in terms of a specific type of formal logic to reconcile the phenomenology of consciousness with the physical world. Ilya Prigogine summarizes his view on complexity, and on the future of quantum theory, which goes beyond the present formalism, and goes on to comment on the problem of consciousness. Matti Pitkanen identifies the place for consciousness in a unifying topological geometro-dynamics theory. Colin McGinn argues against classical materialism. Dick Bierman gives an overview of anomalous phenomena. He identifies a decline effect, and discusses different possible interpretations. Philip Van Loocke closes the volume with a discussion on how deep teleology in cellular systems may relate to consciousness. (shrink)

ABSTRACTResearch Objective: This study focuses on ADs in the Netherlands and introduces a cross‐cultural perspective by comparing it with other countries.Methods: A questionnaire was sent to a panel comprising 1621 people representative of the Dutch population. The response was 86%.Results: 95% of the respondents didn't have an AD, and 24% of these were not familiar with the idea of drawing up an AD. Most of those familiar with ADs knew about the Advanced Euthanasia Directive . Both low education and the (...) presence of a religious conviction that plays an important role in one's life increase the chance of not wanting to draw up an AD. Also not having experienced a request for euthanasia from someone else, and the inconceivability of asking for euthanasia yourself, increase the chance of not wanting to draw up an AD.Discussion: This study shows that the subjects of palliative care and end‐of‐life‐decision‐making were very much dominated by the issue of euthanasia in the Netherlands. The AED was the best known AD; and factors that can be linked to euthanasia play an important role in whether or not people choose to draw up an AD. This differentiates the Netherlands from other countries and, when it comes to ADs, the global differences between countries and cultures are still so large that the highest possible goals, at this moment in time, are observing and possibly learning from other cultural settings. (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)

Obtaining ‘informed consent’ from every individual participant involved in health research is a mandatory ethical practice. Informed consent is a process whereby potential participants are genuinely informed about their role, risk and rights before they are enrolled in the study. Thus, ethics committees in most countries require ‘informed consent form’ as part of an ethics application which is reviewed before granting research ethics approval. Despite a significant increase in health research activity in low-and middle-income countries in recent years, only limited (...) work has been done to address ethical concerns. Most ethics committees in LMICs lack the authority and/or the capacity to monitor research in the field. This is important since not all research, particularly in LMICs region, complies with ethical principles, sometimes this is inadvertently or due to a lack of awareness of their importance in assuring proper research governance. With several examples from Nepal, this paper reflects on the steps required to obtain informed consents and highlights some of the major challenges and barriers to seeking informed consent from research participants. At the end of this paper, we also offer some recommendations around how can we can promote and implement optimal informed consent taking process. We believe that paper is useful for researchers and members of ethical review boards in highlighting key issues around informed consent. (shrink)

Can business humanize its stakeholders? And if so, how does this relate to moral consideration for stakeholders? In this paper we compare two business orientations that are relevant for current business theory and practice: a stakeholder orientation and a profit orientation. We empirically investigate the causal relationships between business orientation, humanization, and moral consideration. We report the results of six experiments, making use of different operationalizations of a stakeholder and profit orientation, different stakeholders, and different participant samples. Our findings support (...) the prediction that individual stakeholders observing a stakeholder-oriented firm see the firm’s other stakeholders as more human than individual stakeholders observing a profit-oriented firm. This humanization, in turn, increases individual stakeholders’ moral consideration for the firm’s other stakeholders. Our findings underscore the importance of humanization for stakeholders’ moral consideration for each other. This paper contributes to a deeper understanding of the firm as a moral community of stakeholders. Specifically, we move away from a focus on managers, and how they can make business more moral. Instead we direct attention to stakeholders, and how business can make these stakeholders more moral. (shrink)

Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is the (...) contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people’s perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization. (shrink)

In ‘belief revision’ a theory\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\cal K}$$\end{document} is revised with a formula φ resulting in a revised theory \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\cal K}\ast\varphi$$\end{document}. Typically, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\neg\varphi$$\end{document} is in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\cal K}$$\end{document}, one has to give up belief in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\neg\varphi$$\end{document} by a process (...) of retraction, and φ is in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\cal K}\ast\varphi$$\end{document}. We propose to model belief revision in a dynamic epistemic logic. In this setting, we typically have an information state (pointed Kripke model) for the theory \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\cal K}$$\end{document} wherein the agent believes the negation of the revision formula, i.e., wherein \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$B\neg\varphi$$\end{document} is true. The revision with φ is a program *φ that transforms this information state into a new information state. The transformation is described by a dynamic modal operator [*φ], that is interpreted as a binary relation [ [*φ] ] between information states. The next information state is computed from the current information state and the belief revision formula. If the revision is successful, the agent believes φ in the resulting state, i.e., Bφ is then true. To make this work, as information states we propose ‘doxastic epistemic models’ that represent both knowledge and degrees of belief. These are multi-modal and multi-agent Kripke models. They are constructed from preference relations for agents, and they satisfy various characterizable multi-agent frame properties. Iterated, revocable, and higher-order belief revision are all quite natural in this setting. We present, for an example, five different ways of such dynamic belief revision. One can also see that as a non-deterministic epistemic action with two alternatives, where one is preferred over the other, and there is a natural generalization to general epistemic actions with preferences. (shrink)