Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...) confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

Moral case deliberation (MCD) is a specific form of clinical ethics, aiming to stimulate ethical reflection in daily practice in order to improve the quality of care. This article focuses on the implementation of MCD in nursing homes and the questions how and where to organize MCD. The purpose of this study was to evaluate one way of organizing MCD in two Dutch nursing homes. In both of these nursing homes the MCD groups had a heterogeneous composition and were organized (...) apart from existing institutional communication structures. As part of a naturalistic evaluation, systematic observations, interviews and focus groups were completed. The findings indicate that the heterogeneous composition and MCD meetings separate from existing structures have benefits. However, the participants also reported negative experiences. This gives rise to the question whether a mixed MCD group which meets separately is an effective way to embed MCD as an instrument for reflection on moral issues in daily practice. We conclude that there is no single answer to that question. In the end, the two implementation strategies (i.e. within existing communication structures and a mixed MCD group) can be complementary to each other. (shrink)

Clinical ethics support mechanisms in healthcare are increasing but little is known about the specific developments in elderly care. The aim of this paper is to present a systematic literature review on the characteristics of existing ethics support mechanisms in institutional elderly care. A review was performed in three electronic databases . Sixty papers were included in the review. The ethics support mechanisms are classified in four categories: ‘institutional bodies’ ; ‘frameworks’ ; ‘educational programmes and moral case deliberation’; and ‘written (...) documents and policies’. For each category the goals, methods and ways of organising are described. Ethics support often serves several goals and can be targeted at various levels: case, professional or organisation. Over the past decades a number of changes have taken place in the development of ethics support in elderly care. Considering the goals, ethics support has become more outreaching and proactive, aiming to qualify professionals to integrate ethics in daily care processes. The approaches in clinical ethics support have become more diverse, more focused on everyday ethical issues and better adapted to the concrete learning style of the nursing staff. Ethics support has become less centrally organised and more connected to local contexts and primary process within the organisation. (shrink)

Ethics support is called for to improve the quality of care in elderly institutions. Various forms of ethics support are presented, but the needs for ethics support remain unknown. Using a mixed-methods design, this article systematically investigates the specific needs for ethics support in elderly care. The findings of two surveys, two focus groups and 17 interviews demonstrate that the availability of ethics support is limited. There is a need for ethics support, albeit not unconditionally. Advice-based forms of ethics support (...) are less appropriate as they are removed from practice. Ethics support should be tailored to the often mundane and easily overlooked moral issues that arise in long-term care. Attention should also be given to the learning styles of nurses who favour experiential learning. Raising awareness and developing a climate of openness and dialogue are the most suitable ways to deal with the mundane moral issues in elderly care. (shrink)

Research on self-agency emphasizes the importance of a comparing mechanism, which scans for a match between anticipated and actual outcomes, in the subjective experience of doing.This study explored the “feeling of doing” in individuals with checking symptoms by examining the mechanism involved in the experienced agency for outcomes that matched expectations. This mechanism was explored using a task in which the subliminal priming of potential action-effects generally enhances people’s feeling of causing these effects when they occur, due to the unconscious (...) perception of a match between primed and observed outcomes. The main result revealed a negative relationship between checking and self-agency for observed outcomes that were primed prior to actions. This suggests that checking individuals fail to grasp the correspondence between actual outcomes of their actions and expected ones. We discuss the possible role of undermined self-agency in checking phenomena and its relationship with cognitive dysfunction. (shrink)

Exploration of Alfred North Whitehead's influence on Maurice Merleau-Ponty's ontology of nature.

_Exploration of Alfred North Whitehead's influence on Maurice Merleau-Ponty's ontology of nature._.

This study examined cognitive representations of routine action, through the assessment of level of agency, in individuals with sub-clinical checking. The level of agency stems from Action Identification Theory [Vallacher, R. R., Wegner, D. M. . Levels of personal agency: Individual variation in action identification. Journal of Personality and Social Psychology 57, 660–671], which states that how actions are usually identified reflects the predominant accessibility of internal representation . Furthermore, this framework proposed that altered action regulation is related to low-level (...) of agency . In the current study, the main result indicated that checking symptoms were related to a low-level of agency, that is, individuals with sub-clinical checking identified habitual actions on the basis of instrumental aspects. This seems to indicate that checkers may act with a lack of goal representations. The results are discussed in terms of the role of low-level of agency in checking phenomena and related cognitive dysfunction. (shrink)

The article explores the relationship between Baukunst and Zeitwille in the practice and pedagogy of Ludwig Mies van der Rohe, and the significance of the notions of civilization and culture for his philosophy of education and design practice. Focusing on the negation of metropolitan life and mise en scene of architectural space as its starting point, it examines how Georg Simmel’s notion of objectivity could be related to Mies’s understanding of civilization. Its key insight is to recognize that Mie’s practice (...) and pedagogy was directed by the idea that architecture should capture the driving force of civilization. The paper also summarizes the foundational concepts of Mies’s curriculum in Chicago. It aims to highlight the importance of the notions of Zeitwille and impersonality in Mies van der Rohe’s thought and to tease apart the tension between the impersonality and the role of the autonomous individual during the modernist era. (shrink)

In paediatric oncology, research and treatments are often closely combined, which may compromise voluntary informed consent of parents. We identified two key scenarios in which voluntary informed consent for paediatric oncology studies is potentially compromised due to the intertwinement of research and care. The first scenario is inclusion by the treating paediatric oncologist, the second scenario concerns treatments confined to the research context. In this article we examine whether voluntary informed consent of parents for research is compromised in these two (...) scenarios, and if so whether this is also morally problematic. For this, we employ the account of voluntary consent from Nelson and colleagues, who assert that voluntary consent requires substantial freedom from controlling influences. We argue that, in the absence of persuasion or manipulation, inclusion by the treating physician does not compromise voluntariness. However, it may function as a risk factor for controlling influence as it narrows the scope within which parents make decisions. Furthermore, physician appeal to reciprocity is not controlling as it constitutes persuasion. In addition, framing information is a form of informational manipulation and constitutes a controlling influence. In the second scenario, treatments confined to the research context qualify as controlling if the available options are restricted through manipulation of options. Although none of the influences is morally problematic in itself, a combination of influences may create morally problematic instances of involuntary informed consent. Therefore, safeguards should be implemented to establish an optimal environment for parents to provide voluntary informed consent in an integrated research-care context. (shrink)

In paediatric oncology, research and treatments are often closely combined, which may compromise voluntary informed consent of parents. We identified two key scenarios in which voluntary informed consent for paediatric oncology studies is potentially compromised due to the intertwinement of research and care. The first scenario is inclusion by the treating paediatric oncologist, the second scenario concerns treatments confined to the research context. In this article we examine whether voluntary informed consent of parents for research is compromised in these two (...) scenarios, and if so whether this is also morally problematic. For this, we employ the account of voluntary consent from Nelson and colleagues, who assert that voluntary consent requires substantial freedom from controlling influences. We argue that, in the absence of persuasion or manipulation, inclusion by the treating physician does not compromise voluntariness. However, it may function as a risk factor for controlling influence as it narrows the scope within which parents make decisions. Furthermore, physician appeal to reciprocity is not controlling as it constitutes persuasion. In addition, framing information is a form of informational manipulation and constitutes a controlling influence. In the second scenario, treatments confined to the research context qualify as controlling if the available options are restricted through manipulation of options. Although none of the influences is morally problematic in itself, a combination of influences may create morally problematic instances of involuntary informed consent. Therefore, safeguards should be implemented to establish an optimal environment for parents to provide voluntary informed consent in an integrated research-care context. (shrink)

Background Notwithstanding the need to produce evidence-based knowledge on medications for pregnant women, they remain underrepresented in clinical research. Sometimes they are excluded because of their supposed vulnerability, but there are no universally accepted criteria for considering pregnant women as vulnerable. Our aim was to explore whether and if so to what extent pregnant women are vulnerable as research subjects. Method We performed a conceptual and empirical analysis of vulnerability applied to pregnant women. Analysis A conceptual analysis supports Hurst's definition (...) of vulnerability. Consequently, we argue that pregnant women are vulnerable if they encounter an identifiably increased likelihood of incurring additional or greater wrong. According to the literature, this increased likelihood could exist of four alleged features for pregnant women's vulnerability: informed consent, susceptibility to coercion, higher exposure to risk due to lack of knowledge, vulnerability of the fetus. Discussion Testing the features against Hurst's definition demonstrates that they all concern the same issue: pregnant women are only vulnerable because a higher exposure to risk due to lack of scientific knowledge comprises an increased wrong. Research Ethics Committees have a responsibility to protect the vulnerable, but a higher exposure to risk due to lack of scientific knowledge is a much broader issue and also needs to be addressed by other stakeholders. Conclusions The only reason why pregnant women are potentially vulnerable is to the extent that they are increasingly exposed to higher risks due to a lack of scientific knowledge. Accordingly, the discussion can advance to the development of practical strategies to promote fair inclusion of pregnant women in clinical research. (shrink)

This essay surveys the main objections to aesthetic hedonism, the view that aesthetic value is reducible to the value of aesthetic pleasure or experience. Hedonism is the dominant view of aesthetic value, but a spate of recent criticisms has drawn its accuracy into question. I introduce some distinctions crucial to the criticisms, before using the bulk of the essay to identify and review six major lines of argument that hedonism's critics have employed against it. Whether or not these arguments suffice (...) to refute hedonism decisively, I argue that its privileged status, as the sole contender in aesthetic value theory, is detrimental to downstream research on aesthetic phenomena. The essay concludes with an overview of current work and promising avenues of inquiry into non-hedonic alternatives. (shrink)

There is ambiguity with regard to what counts as an acceptable level of risk in clinical research in pregnant women and there is no input from stakeholders relative to such research risks. The aim of our paper was to explore what stakeholders who are actively involved in the conduct of clinical research in pregnant women deem an acceptable level of risk for pregnant women in clinical research. Accordingly, we used the APOSTEL VI study, a low-risk obstetrical randomised controlled trial, as (...) a case-study. We conducted a prospective qualitative study using 35 in-depth semi-structured interviews and one focus group. We interviewed healthcare professionals, Research Ethics Committee members and regulators who are actively involved in the conduct of clinical research in pregnant women, in addition to pregnant women recruited for the APOSTEL VI case-study in the Netherlands. Three themes characterise the way stakeholders view risks in clinical research in pregnant women in general. Additionally, one theme characterises the way healthcare professionals and pregnant women view risks with respect to the case-study specifically. First, ideas on what constitutes an acceptable level of risk in general ranged from a preference for zero risk for the foetus up to minimal risk. Second, the desirability of clinical research in pregnant women in general was questioned altogether. Third, stakeholders proposed to establish an upper limit of risk in potentially beneficial clinical research in pregnant women in order to protect the foetus and the pregnant woman from harm. Fourth and finally, the case-study illustrates that healthcare professionals’ individual perception of risk may influence recruitment. Healthcare professionals, RECs, regulators and pregnant women are all risk adverse in practice, possibly explaining the continuing underrepresentation of pregnant women in clinical research. Determining the acceptable levels of risk on a universal level alone is insufficient, because the individual perception of risk also influences behaviour towards pregnant women in clinical research. Therefore, bioethicists and researchers might be interested in changing the perception of risk, which could be achieved by education and awareness about the actual benefits and harms of inclusion and exclusion of pregnant women. (shrink)

The last two volumes of Giorgio Agamben’s Homo Sacer series are concerned with developing a theory of use. This article offers a critical assessment of the two concepts, use and form-of-life, that form the heart of this theory: how do these two notions offer a solution to the problem of bare life that forms the core of the Homo Sacer series? First, the author describes how the original problem of bare life is taken up in The Use of Bodies and (...) how the notion of use offers an important additional characteristic of bare life. Second, inspired by Foucault’s analysis of ancient Cynicism, the author discusses in which sense the type of ‘solution’ Agamben offers to the problem of bare life might be seen as an heir to ancient Cynicism and how this interpretation clarifies his connection of form-of-life and exile. Third, the author critically assesses the different usages of use that we can find in Agamben, by comparing how Franciscan usus, Pauline chrēsis and Platonic chrēsis are taken up in his analysis. Fourth, following Foucault, the author deepens the Platonic sense of use and its relation to taking care of justice. The article concludes with a critical assessment of Agamben’s reading of Plato’s myth of Er, in which the motifs of use, exile, and care are gathered. (shrink)

We investigated how the perception of being dissimilar to others at work relates to employees’ felt inclusion, distinguishing between surface-level and deep-level dissimilarity. In addition, we tested the indirect relationships between surface-level and deep-level dissimilarity and work-related outcomes, through social inclusion. Furthermore, we tested the moderating role of a climate for inclusion in the relationship between perceived dissimilarity and felt inclusion. We collected survey data from 891 employees of a public service organization. An ANOVA showed that felt inclusion was lower (...) for individuals who perceived themselves as deep-level dissimilar compared to individuals who perceived themselves as similar, while felt inclusion did not differ among individuals who perceived themselves as surface-level similar or dissimilar. Furthermore, a moderated mediation analysis showed a negative conditional indirect relationship between deep-level dissimilarity and work-related outcomes through felt inclusion. Interestingly, while the moderation analysis showed that a positive climate for inclusion buffered the negative relationship between deep-level dissimilarity and felt inclusion, it also positively related to feelings of inclusion among all employees, regardless of their (dis)similarity. This research significantly improves our understanding of how perceived dissimilarity affects employees by distinguishing between surface-level and deep-level dissimilarity and by demonstrating the importance of a climate for inclusion. (shrink)

A study of the rhetorical and political strategy adopted by the Roman orator and statesman Cicero as a newcomer in Roman republican politics. Henriette van der Blom argues that Cicero advertised himself as a follower of chosen models of behaviour from the past - his role models - and in turn presented himself as a role model to others.

This work brings together Philip van der Eijk's previously published essays on the close connections that existed between medicine and philosophy throughout antiquity. Medical authors such as the Hippocratic writers, Diocles, Galen, Soranus and Caelius Aurelianus elaborated on philosophical methods such as causal explanation, definition and division and applied key concepts such as the notion of nature to their understanding of the human body. Similarly, philosophers such as Plato and Aristotle were highly valued for their contributions to medicine. This interaction (...) was particularly striking in the study of the human soul in its relation to the body, as illustrated by approaches to specific topics such as intellect, sleep and dreams, and diet and drugs. With a detailed introduction surveying the subject as a whole and an essay on Aristotle's treatment of sleep, this wide-ranging and accessible collection is essential reading for the student of ancient philosophy and science. (shrink)

A diplomatic edition of a commentary by Bcom-ldan-ral-gri (1227-1305), a Tibetan Buddhist scholar of the Kadampa (Bka-gdams-pa) tradition, on the "Pramāṇasamuccaya" written by the Indian Buddhist logician, Dignāga (c. 480-540 CE); includes extensive introductory material on the life and work of Dignāga, and reception of this treatise in Tibet.

Review of Jan van der Stoep's published PhD dissertation on the work of Pierre Bourdieu.en de politieke filosofie van het multiculturalisme Kok Kampen 2005. My review is in English. van der Stoep's book is in Dutch with an English summary.

Over the past decades, both wild and domesticated insect pollinators are in dramatic decline, which puts at stake the existence of species, ecosystem resilience and global food security. Globally, 87 of major food crops depend on animal pollination. Together these account for 35 % of the world food production volume. Pollinator mediated crops are indispensable for essential micronutrients in the human diet. Many ornamental plants as well as crops for fibre, fodder, biofuels, timber and phytopharmaceuticals also depend on insect pollinators. (...) This article aims to map the current situation of pollinators worldwide, with a focus on the critical role of pollinators in the human food chain and ecosystem sustainability, their intrinsic and extrinsic value, as well as the causes of their declines and the interventions needed to conserve them, in order to develop an argument for the importance of conserving and restoring pollinator populations and diversity. The present pollinator crisis threatens global and local food security, can worsen the problems of hidden hunger, erodes ecosystem resilience, and can destabilise ecosystems that form our life support system. An integrated approach that simultaneously addresses the key drivers is needed. This includes creation and restoration of floral and nesting resources, a global phase out of prophylactic use of neonicotinoids and fipronil, improvement of test protocols in authorisation of agrochemicals, and restoration and maintenance of independence in regulatory science. The authors argue that an international treaty for global pollinator stewardship and pollinator ecosystem restoration should be initiated in order to systemically counteract the current crisis. (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)

This paper was presented at the Second World Congress on Logic and Religion on the sub-topic of logics vis-à-vis illogicalities in religion. It deals with fourteenth-century-logician Thomas Manlevelt’s Ockhamist approach to logic (the ars vetus, strictly speaking) and its ontological outcome: rejection of the existence of substance. Although God, the Trinity, the Blessed Virgin, the Antichrist and the consecrated host keep popping up within the domain of logic, it is argued that Manlevelt kept clear water between logic and theology. Things (...) divine, and especially the transubstantiation of the consecrated host, do however play a crucial role in the development of his idea of the non-existence of substance. It is suggested that this might imply the miraculous nature of the whole universe. (shrink)

The Philosophy of R.G. Collingwood W. J. Van Der Dussen. Collingwood's conclusion is that " ... science, even at its best, always falls short of understanding the facts as they really are"88. Only history is able to realize this. It is another ...

Edith Stein is widely known as a historical figure, a victim of the Holocaust and a saint, but still unrecognised as a philosopher. It was philosophy, however, that constituted the core of her life. Today her complete writings are available to scholars and therefore her thinking can be properly investigated and evaluated. In the final parts of the book, the author shows how Stein's ideas are relevant today, in particular to the ongoing doctrinal and legal debates over the concept of (...) human dignity. (shrink)

A systematic study of testimony rooted in contemporary continental philosophy and drawing on literary case studies. From analytic epistemology to gender theory, testimony is a major topic in philosophy today. Yet, one distinctive approach to testimony has not been fully appreciated: the recent history of contemporary continental philosophy offers a rich source for another approach to testimony. In this book, Gert-Jan van der Heiden argues that a continental philosophy of testimony can be developed that is guided by those forms of (...) bearing witness that attest to limit experiences of human existence, in which the human is rendered mute, speechless, or robbed of a common understanding. In the first part, Van der Heiden explores this sense of testimony in a reading of several literary texts, ranging from Plato’s literary inventions to those of Kierkegaard, Melville, Soucy, and Mortier. In the second part, based on the orientation offered by the literary experiments, Van der Heiden offers a more systematic account of testimony in which he distinguishes and analyzes four basic elements of testimony. In the third part, he shows what this analysis implies for the question of the truth and the truthfulness of testimony. In his discussion with philosophers such as Heidegger, Derrida, Lyotard, Agamben, Foucault, Ricoeur, and Badiou, Van der Heiden also provides an overview of how the problem of testimony emerges in a number of thinkers pivotal to twentieth- and twenty-first-century thought. “The Voice of Misery is a special book. Van der Heiden has presented an argument that is poised to challenge discourse in analytic philosophy, reshape approaches in continental philosophy, and give new orientation to interdisciplinary research in continental philosophy and literary theory. The book will find a large readership across the discipline of philosophy and in several areas of the humanities.” — Theodore George, author of Tragedies of Spirit: Tracing Finitude in Hegel’s Phenomenology. (shrink)

William Whewell’s 19th century philosophy of science is sometimes glossed over as a footnote to Kant. There is however a key feature of Whewell’s account worth noting. This is his appeal to Aristotle’s form/matter hylomorphism as a metaphor to explain how mind and world merge in successful scientific inquiry. Whewell’s hylomorphism suggests a middle way between rationalism and empiricism reminiscent of experience pragmatists like Steven Levine’s view that mind and world are entwined in experience. I argue however that Levine does (...) not adequately explain exactly how mind and world entwine. He could nonetheless do so if he appealed to Whewell’s hylomorphic metaphor. We may prefer a reductive metaphysical explanation, but I suggest that pragmatists only have recourse to metaphor in this case. Both reductive and metaphorical explanations can enjoy great explanatory power if they exhibit a suitable measure of what I will call sematic distance. Semantic distance measures how close or how far apart explanandum and explanans are from each other in meaning. Metaphorical explanation - as evident in Whewell’s hylomorphism and as detailed via the notion of semantic distance - presents a valuable new explanatory tool to those who hold that mind and world are entwined sans recourse to metaphysics. (shrink)

The precautionary principle is often invoked in relation to pregnant women and may be one of the underlying reasons for their continuous underrepresentation in clinical research. The principle is appealing, because potential fetal harm as a result of research participation is considered to be serious and irreversible. In our paper, we explore through conceptual analysis whether and if so how the precautionary principle should apply to pregnant women. We argue that the principle is a decision-making strategy underlying risk-benefit decisions in (...) clinical research, which can be applied to pregnant women. However, the current application is a strong one, leading to the promotion of absolute exclusion or, less often, absolute inclusion of pregnant women. In order to change this paralyzing situation, a shift toward weak precautionary thinking is necessary. Instead of automatic extreme precaution, a balance will be found between harms and potential benefits of including pregnant women in clinical research. (shrink)

In the Netherlands fertility doctors increasingly formulate protocols, which oblige patients to quit their unhealthy lifestyle before they are admitted to IVF procedures. We argue that moral arguments could justify parenting protocols that concern all future parents. In the first part we argue that want‐to‐be parents have moral responsibilities towards their future children to prevent them from harm by diminishing or eliminating risk factors before as well as during the pregnancy. This is because of the future children's potential to become (...) of a certain type, more specifically: a person that will be the want‐to‐be parents' child. Want‐to‐be parents intend to become pregnant and therefore have an additional moral reason to diminish the risks. Also, people who become pregnant unintentionally have the responsibility to prevent their children from harm, unless they become pregnant due to contraception failure. All people not wanting to become pregnant should use contraception methods carefully.In the second part of this paper we translate the want‐to‐be parents' responsibilities into practice. We distinguish four determinants of risk factors: modifiability, chance, severity and effort. We examine some evidence‐based risk factors based on these variables and deduce levels of responsibility.In conclusion, formulating informal requirements for want‐to‐be parents is morally required and therefore also for want‐to‐be parents in need of medical assistance. The protocols developed by fertility doctors in the Netherlands could be seen as the precursor for a general, informal Parenting Protocol that could be developed on the basis of an extended and thoroughly debated risk‐responsibility analysis. (shrink)