This article reports on a survey of the moral problems that Dutch nurses experience during their everyday practice. A questionnaire was developed, based on published literature, panel discussions, in-depth interviews and participation observations. The instrument was tested in a pilot study and proved to be useful. A total of 2122 questionnaires were sent to 91 institutions in seven different health care settings. The results showed that nurses were not experiencing important societal issues such as abortion and euthanasia as morally the (...) most problematic, but rather situations such as verbally aggressive behaviour of colleagues towards patients, keeping silent about errors, and medical treatment given against the wishes of patients. Moral problems occurred especially when nurses experienced feelings of powerlessness with regard to the well-being of patients. Moreover, these moral problems proved to be related to institutional organization, leadership, and collaboration with colleagues and other disciplines. Nurses appeared to have a limited awareness of the moral dimensions of their practice. (shrink)

Background: Issues concerning legislation and regulation with respect to the role of nurses in euthanasia and physician-assisted suicide gave the Minister for Health reason to commission a study of the role of nurses in medical end-of-life decisions in hospitals, home care and nursing homes.Aim: This paper reports the findings of a study of the role of nurses in euthanasia and physician-assisted suicide, conducted as part of a study of the role of nurses in medical end-of-life decisions. The findings for hospitals, (...) home care and nursing homes are described and compared.Method: A questionnaire was sent to 1509 nurses, employed in 73 hospitals, 55 home care organisations and 63 nursing homes. 1179 responses were suitable for analysis. The questionnaire was pilot-tested among 106 nurses, with a response rate of 85%.Results: In 37.0% of cases, the nurse was the first person with whom patients discussed their request for euthanasia or physician-assisted suicide. Consultation between physicians and nurses during the decision-making process took place quite often in hospitals and nursing homes and less frequently in home care situations . In some cases , nurses administered the euthanatics.Conclusions: The results show substantial differences between the intramural sector and the extramural sector , which are probably linked to the organisational structure of the institutions. Consultation between physicians and nurses during the decision-making process needs improvement, particularly in home care. Some nurses had administered euthanatics, although this task is by law exclusively reserved to physicians. (shrink)

With particular reference to Marx's critique of religion.

Professional codes of ethics are regarded as elements of nurses' ethical knowledge base and consequently part of their ethics education. However, research focusing on these codes from an educational viewpoint is scarce. This study explored the need and applicability of nursing codes of ethics in modern health care, their importance in the nursing ethics curriculum, and the need for development of their teaching. A total of 183 Finnish nurse educators and 212 nursing students answered three structured questions, with an opportunity (...) to justify their responses, and one open-ended question. Descriptive statistics and content analysis were used to analyse the data. The results suggest that the existence of the codes was seen as important and their applicability mainly as appropriate, despite new challenges posed by modern health care. The codes were regarded as an important part of nurses' ethics education, but current integrated teaching methods require development. (shrink)

This article presents the attitudes of nurses towards three issues concerning their role in euthanasia and physician-assisted suicide. A questionnaire survey was conducted with 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The study was conducted in the Netherlands between January 2001 and August 2004. The results show that less than half (45%) of nurses would be willing to serve on committees reviewing cases of euthanasia and physician-assisted suicide. More than half of the nurses (58.2%) (...) found it too far-reaching to oblige physicians to consult a nurse in the decision-making process. The majority of the nurses stated that preparing euthanatics (62.9%) and inserting an infusion needle to administer the euthanatics (54.1%) should not be accepted as nursing tasks. The findings are discussed in the context of common practices and policies in the Netherlands, and a recommendation is made not to include these three issues in new regulations on the role of nurses in euthanasia and physician-assisted suicide. (shrink)

In the Netherlands, euthanasia and assisted suicide are formally forbidden by criminal law, but, under certain strictly formulated conditions, physicians are excused for administering these to patients on the basis of necessity. These conditions are bound up with a long process of criteria development. Therefore, physicians still live in uncertainty. Future court decisions may change the criteria. Apart from that, physicians can always be prosecuted. The position of nurses, however, is perfectly clear; they are never allowed to administer euthanasia or (...) assisted suicide. Nevertheless, they should be involved in the decision-making process because they are an important source of information and have consultation skills. The openness of the discussion about these issues in the Netherlands may prevent an escalation of medical or nursing responsibility and falling victim to the ‘slippery slope’. (shrink)

This article presents the attitudes of nurses towards three issues concerning their role in euthanasia and physician-assisted suicide. A questionnaire survey was conducted with 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The study was conducted in the Netherlands between January 2001 and August 2004. The results show that less than half of nurses would be willing to serve on committees reviewing cases of euthanasia and physician-assisted suicide. More than half of the nurses found it (...) too far-reaching to oblige physicians to consult a nurse in the decision-making process. The majority of the nurses stated that preparing euthanatics and inserting an infusion needle to administer the euthanatics should not be accepted as nursing tasks. The findings are discussed in the context of common practices and policies in the Netherlands, and a recommendation is made not to include these three issues in new regulations on the role of nurses in euthanasia and physician-assisted suicide. (shrink)

This article reports on a survey of the moral problems that Dutch nurses experience during their everyday practice. A questionnaire was developed, based on published literature, panel discussions, in-depth interviews and participation observations. The instrument was tested in a pilot study and proved to be useful. A total of 2122 questionnaires were sent to 91 institutions in seven different health care settings. The results showed that nurses were not experiencing important societal issues such as abortion and euthanasia as morally the (...) most problematic, but rather situations such as verbally aggressive behaviour of colleagues towards patients, keeping silent about errors, and medical treatment given against the wishes of patients. Moral problems occurred especially when nurses experienced feelings of powerlessness with regard to the well-being of patients. Moreover, these moral problems proved to be related to institutional organization, leadership, and collaboration with colleagues and other disciplines. Nurses appeared to have a limited awareness of the moral dimensions of their practice. (shrink)

What role do nurses play in euthanasia? How do they experience this role and what should be their ideal role? These are the questions of a study undertaken to gain insight into the role of nurses in euthanasia. Answers to these questions were derived from 20 semistructured in-depth interviews with nurses employed in a Dutch hospital. To make clear the role of nurses in euthanasia, the issue was split up into four phases: observation of a request for euthanasia; decision making; (...) carrying out of the request; and after-care. This article is a brief report on the most important results regarding these four phases. Special attention will be paid to nurses who have conscientious objections. To evaluate the study results, an unambiguous interpretation of the concept of ‘euthanasia’ is of most importance. For that reason, Dutch laws and other regulations concerning euthanasia will be explained. (shrink)

This article presents the results of a qualitative study on the ethical aspects of inclusion practice for radiotherapy patients taking part in clinical research. The study focused on the standards and values of this process. Patients and physicians were interviewed about their views and experiences. Analysis of these interviews showed that candidate research participants need better protection from unwanted factors that could influence their choice about participation. Researchers need proper education about regulation, codes and directives in the field of research (...) ethics, and they should be aware of the underlying ethical concepts of these regulations. A sound institutional ethics policy is necessary in order to guide medical staff in decisions about the inclusion of patients in trials. (shrink)

This study explored the experiences and views of Dutch nurses on the content, function, dissemination and implementation of their codes of ethics. A total of 39 participants, who differed in age, qualifications, length of work experience and health care setting, took part in focus groups. The findings revealed common unfamiliarity with and a rather implicit use of codes, and negative comments on the growing number of codes available in the Netherlands. Limited dissemination, implementation and functioning of codes of ethics were (...) also identified. The findings were discussed using concepts from the literature, nursing practice and personal experience. (shrink)

This article reports the findings of a study into the role of Dutch nurses in the alleviation of pain and symptoms with a life-shortening intention, conducted as part of a study into the role of nurses in medical end-of-life decisions. A questionnaire survey was carried out using a population of 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The response rate was 82.0%; 78.1% (1179) were suitable for analysis. The results show that in about half (...) of the cases (55.8%) nurses were involved in the decision making by the physician and that nurses were frequently (81.5%) involved in administering the medication. The authors' conclusion is that alleviation of pain and symptoms with a life-shortening intention represents a `grey' area, in which physicians and nurses act on the basis of personal ethical norms rather than legal rules, professional guidelines or shared moral values. (shrink)

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses’ opinions of the content and function of codes and their use in nursing practice. A total of 49 focus (...) groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be ‘paper tigers’ with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice. (shrink)

This study analysed teaching of nurses’ codes of ethics in basic nursing education in Finland. A total of 183 educators and 214 students responded to a structured questionnaire. The data was analysed by SPSS. Teaching of nurses’ codes was rather extensive. The nurse-patient relationship was highlighted. Educators assessed their teaching statistically significantly more extensive than what students’ perceptions were. The use of teaching and evaluation methods was conventional, but differences between the groups concerning the use of these methods were statistically (...) significant. Students’ knowledge of and their ability to apply the codes was mediocre. Most educators and students assessed educators’ knowledge of the codes as adequate for teaching. These educators also taught the codes more extensively and these students perceived the teaching as more extensive. Otherwise educators’ and students’ socio-demographic variables had little association with the teaching. Research should focus on the organization and effectiveness of ethics education, and on educators’ competence. (shrink)

From Kant’s first published work to recent articles in the physics literature, philosophers and physicists have long sought an answer to the question, why does space have three dimensions. In this paper, I will flesh out Kant’s claim with a brief detour through Gauss’ law. I then describe Büchel’s version of the common argument that stable orbits are possible only if space is three-dimensional. After examining objections by Russell and van Fraassen, I develop three original criticisms of my own. These (...) criticisms are relevant to both historical and contemporary proofs of the dimensionality of space (in particular, a recent one by Burgbacher, F. Lämmerzahl, C., and Macias). In general I argue that modern “proofs” of the dimensionality of space have gone off track. (shrink)

This is surely a bit of Socrates' famous irony. He draws the analogy to explain how his friends should regard poetry as they regretfully banish it from the ideal state. But lovers were no more sensible then than they are now. The advice to banish poetry, undermined already by Plato's own delight and skill in drama, is perhaps undermined still further by this evocation of a 'sensible' lover who counts love so well lost. Yet Socrates' image is one of avowed (...) rationality and prudence. The sensible lover imitates the older literary example of Ulysses' tying himself to the mast. (The example belongs therefore to the class of problems treated in Elster (1979)). Both this lover and Ulysses foresee that under certain possible future conditions, their opinions, values and preferences will or would differ from what they are now, in a very definite fashion. To what extent is such foresight possible? Correspondingly (when we do not claim foreknowledge) to what extent is such opinion reasonable, rational, coherent, or consistent in some suitably broad sense? It is not easy to understand exactly what is possible or even logically permissible in this respect. In an earlier paper, "Belief and the Will", I argued for a principle ("Reflection") to govern such deliberation. Here I will both generalize the treatment of opinion in "Belief and the Will" and respond to criticism. Critical examples mainly resembled the story of Ulysses who foresaw a period of dysfunction (at the sound 2 of the sirens) in his epistemic and/or doxastic future. Other criticism focused on the model of opinion used (precise numerical subjective probability) and on the merits of Dutch Book arguments. The present argument will not rely on Dutch Book arguments and strategies, and the Reflection principle will be formulated so as to apply also to vague opinion. (shrink)

The empirical-transcendental debate in philosophy of technology, as debates go, took a turn toward the counterposing of the two perspectives, ‘empirical’-pragmatic-pragmatist versus ‘transcendental’-critical. Postphenomenology aligns itself with the former standpoint, and it is in this spirit that commentators have criticized it for its too-instrumentalist stance and lack of overarching, i.e., transcendental orientation. But the positions may have become too starkly delineated in order for the debate to reach any breakthrough: a seemingly unbridgeable gap yawns between the stances of ‘technology with (...) a small “t”’ and ‘Technology with a capital “T.”' Is there any way to reorient the debate? In this paper I propose to do so by considering whether there would be some way of arriving from one end of the spectrum to the other—crossing the gap. Exploring the purported wasteland in between “technology” and “Technology” by way of object-oriented ontology (OOO)—Harman, Morton—we can find it actually filled with countless gaps, adhering to every thing. Following the radical insights of OOO, we’d have to attest to a ‘thing-transcendentality.’ The ‘gap,’ then, that seemed so threatening and all-encompassing, becomes smeared out, levelled down to a multiplicity of perspectives. And this casts the debate, with its purported strict tension between ‘empirical’ and ‘transcendental’ positions, in fresh terms, opening up new ways for studying how the two interrelate. (shrink)

We discuss games of both perfect and imperfect information at two levels of structural detail: players’ local actions, and their global powers for determining outcomes of the game. We propose matching logical languages for both. In particular, at the ‘action level’, imperfect information games naturally model a combined ‘dynamic-epistemic language’ – and we find correspondences between special axioms and particular modes of playing games with their information dynamics. At the ‘outcome level’, we present suitable notions of game equivalence, plus some (...) simple representation results. (shrink)

Logic is not just about single-agent notions like reasoning, or zero-agent notions like truth, but also about communication between two or more people. What we tell and ask each other can be just as 'logical' as what we infer in Olympic solitude. We show how such interactive phenomena can be studied systematically by merging epistemic and dynamic logic.

A basic aim of E. Beth's work in philosophy of science was to explore the use of formal semantic methods in the analysis of physical theories. We hope to show that a general framework for Beth's semantic analysis is provided by the theory of semi-interpreted languages, introduced in a previous paper. After developing Beth's analysis of nonrelativistic physical theories in a more general form, we turn to the notion of the 'logic' of a physical theory. Here we prove a result (...) concerning the conditions under which semantic entailment in such a theory is finitary. We argue, finally, that Beth's approach provides a characterization of physical theory which is more faithful to current practice in foundational research in the sciences than the familiar picture of a partly interpreted axiomatic theory. (shrink)