A theory of the joint measurement of quantum mechanical observables is generalized in order to make it applicable to the measurement of the local observables of field theory. Subsequently, the property of local commutativity, which is usually introduced as a postulate, is derived by means of the theory of measurement from a requirement of mutual nondisturbance, which, for local observables performed at a spacelike distance from each other, is interpreted as a requirement of macrocausality. Alternative attempts at establishing a deductive (...) relationship between relativistic causality and local commutativity are reviewed, but found wanting, either because of the assumption of an unwarranted objectivity of the object system (algebraic approach) or because of the use of a projection postulate (operational approach). Finally, the quantum mechanical nonobjectivity is related to certain features of nonlocality which are present in the formalism of quantum mechanics. (shrink)

The problem of simultaneous measurement of incompatible observables in quantum mechanics is studied on the one hand from the viewpoint of an axiomatic treatment of quantum mechanics and on the other hand starting from a theory of measurement. It is argued that it is precisely such a theory of measurement that should provide a meaning to the axiomatically introduced concepts, especially to the concept of observable. Defining an observable as a class of measurement procedures yielding a certain prescribed result for (...) the probability distribution of the set of values of some quantity (to be described by the set of eigenvalues of some Hermitian operator), this notion is extended to joint probability distributions of incompatible observables. It is shown that such an extension is possible on the basis of a theory of measurement, under the proviso that in simultaneously measuring such observables there is a disturbance of the measurement results of the one observable, caused by the presence of the measuring instrument of the other observable. This has as a consequence that the joint probability distribution cannot obey the marginal distribution laws usually imposed. This result is of great importance in exposing quantum mechanics as an axiomatized theory, since overlooking it seems to prohibit an axiomatic description of simultaneous measurement of incompatible observables by quantum mechanics. (shrink)

Two different concepts of distinguishability are often mixed up in attempts to derive in quantum mechanics the symmetry of the wave function from indistinguishability of identical particles. Some of these attempts are analyzed and shown to be defective. It is argued that, although identical particles should be considered as observationally indistinguishable in symmetric states, they may be considered to be conceptually distinguishable. These two notions of distinguishability have quite different physical origins, the former one being related to observations while the (...) latter has to do with the preparation of the system. (shrink)

Much of what we know and see of ethics support, in literature and during trainings, workshops and conferences, derives from clinical ethicists working at academic medical centers. Besides the probl...

The axiomatic approaches of quantum mechanics and relativity theory are compared with approaches in which the theories are thought to describe readings of certain measurement operations. The usual axioms are shown to correspond with classes of ideal measurements. The necessity is discussed of generalizing the formalisms of both quantum mechanics and relativity theory so as to encompass more realistic nonideal measurements. It is argued that this generalization favours an empiricist interpretation of the mathematical formalisms over a realist one.

The validity of the conclusion to the nonlocality of quantum mechanics, accepted widely today as the only reasonable solution to the EPR and Bell issues, is questioned and criticized. Arguments are presented which remove the compelling character of this conclusion and make clear that it is not the most obvious solution. Alternative solutions are developed which are free of the contradictions related with the nonlocality conclusion. Firstly, the dependence on the adopted interpretation is shown, with the conclusion that the alleged (...) nonlocality property of the quantum formalism may have been reached on the basis of an interpretation that is unnecessarily restrictive. Secondly, by extending the conventional quantum formalism along the lines of Ludwig and Davies it is shown that the Bell problem may be related to complementarity rather than to nonlocality. Finally, the dependence on counterfactual reasoning is critically examined. It appears that locality on the quantum level may still be retained provided one accepts a newly proposed principle of nonreproducibility at the individual quantum level as an alternative of quantum nonlocality. It is concluded that the locality principle can retain its general validity, in full conformity with all experimental data. (shrink)

The Copenhagen interpretation is critically considered. A number of ambiguities, inconsistencies and confusions are discussed. It is argued that it is possible to purge the interpretation so as to obtain a consistent and reasonable way to interpret the mathematical formalism of quantum mechanics, which is in agreement with the way this theory is dealt with in experimental practice. In particular, the essential role attributed by the Copenhagen interpretation to measurement is acknowledged. For this reason it is proposed to refer to (...) it as a neo-Copenhagen interpretation. (shrink)

The EPR problem is studied both from an instrumentalistic and from a realistic point of view. Bohr's reply to the EPR paper is analyzed and demonstrated to be not completely representative of Bohr's general views on the possibility of defining properties of a microscopic object. A more faithful Bohrian answer would not have led Einstein to the conclusion that Bohr's completeness claim of quantum mechanics implies nonlocality. The projection postulate, already denounced in 1936 by Margenau as the source of the (...) EPR paradox, is found to be also at the origin of the nonlocality conundrum. Its unobservability in EPR-like experiments is demonstrated, thus showing the redundancy of the idea of nonlocality in the instrumentalist interpretation of quantum mechanics. It is argued that also from a realist point of view there is no reason to assume nonlocality. The relevance of Bohm's quantum potential and of Bell's inequalities with respect to the (non)locality problem is discussed. (shrink)

In the Copenhagen interpretation the Heisenberg inequality ΔQΔP≥ℏ/2 is interpreted as the mathematical expression of the concept of complementarity, quantifying the mutual disturbance necessarily taking place in a simultaneous or joint measurement of incompatible observables. This interpretation was criticized a long time ago and has recently been challenged in an experimental way. These criticisms can be substantiated by using the generalized formalism of positive operator-valued measures, from which an inequality, different from the Heisenberg inequality, can be derived, precisely illustrating the (...) Copenhagen concept of complementarity. The different roles of preparation and measurement in creating uncertainty in quantum mechanics are discussed. (shrink)

A partial ordering in the class of observables (∼ positive operator-valued measures, introduced by Davies and by Ludwig) is explored. The ordering is interpreted as a form of nonideality, and it allows one to compare ideal and nonideal versions of the same observable. Optimality is defined as maximality in the sense of the ordering. The framework gives a generalization of the usual (implicit) definition of self-adjoint operators as optimal observables (von Neumann), but it can, in contrast to this latter definition, (...) be justified operationally. The nonideality notion is compared to other quantum estimation theoretic methods. Measures for the amount of nonideality are derived from information theory. (shrink)

The South African-Dutch research group responsible for this article started its activities in 2012 by looking at religious tolerance as a means of addressing the tendency for religious intolerance, extremism and fundamentalism. While tolerance seemed to be a promising way to counter religious intolerable behaviour, some shortcomings also became apparent. For example, the concept of tolerance includes an aspect of passivity towards others who adhere to another religion. The concept also does not appear to be able to respond to attitudes (...) and values such as respect, human rights and diversity. Accurate investigation of this problem, both conceptually and empirically, led to the understanding that hospitality is a concept that embodies more active adaptation to those who are different. Hospitality, therefore, seems to be a more promising concept than tolerance for reducing religious tension between individuals and groups. The inner contradiction discovered by Derrida in the notion of hospitality does not detract from the concept of being defined from a Biblical point of view. Hospitality can also be taught to young people. Although there are no formal provisions for hospitality in the national curricula, an analysis of the Dutch and South African national curricula shows that there is room for hospitality education. (shrink)

Until recently, moral case deliberation (MCD) sessions have mostly been facilitated by external experts, mainly professional ethicists. We have developed a train the facilitator programme for healthcare professionals aimed at providing them with the competences needed for being an MCD facilitator. In this paper, we present the first results of a study in which we evaluated the programme. We used a mixed methods design. One hundred and twenty trained healthcare professionals and five trainers from 16 training groups working in different (...) healthcare organisations throughout the Netherlands were included. After completion of the programme, participants feel sufficiently confident and equipped to facilitate an MCD session. Feeling competent does not mean that participants have no doubts or questions left. Rather, they are aware of their limitations and see the need for continuous learning. According to the respondents, the actual exercise of facilitating MCD during and in between the training sessions contributed most to the development of competences necessary for being an MCD facilitator. Respondents without prior experience of participating in MCD sessions felt less competent after the training than those who had participated in MCD sessions before. Self-attributed competence varied between participants with different professional backgrounds. (shrink)

The evaluation of the European Moral Case Deliberation Outcomes project (Euro-MCD) has resulted in a revised evaluation instrument, knowledge about the content of MCD (moral case deliberation), and the perspectives of those involved. In this paper, we report on a perspective that has been overlooked, the facilitators’. We aim to describe facilitators’ perceptions of high-quality moral case deliberation and their Euro-MCD sessions. The research took place in Norway, Sweden, and the Netherlands using a survey combined with interviews with 41 facilitators. (...) Facilitators’ perceived that attaining a high-quality MCD implies fostering a safe and respectful atmosphere, creating a wondering mode, being an attentive authority, developing moral reflective skills, reaching a common understanding, and ensuring organisational prerequisites for the MCD sessions. Our central conclusion is that efforts at three levels are required to attain a high-quality MCD: trained and virtuous facilitator; committed, respectful participants; and organizational space. Furthermore, managers have a responsibility to prepare MCD participants for what it means to take part in MCD. (shrink)

The problem of joint measurement of incompatible observables is investigated. Measurements are represented by positive operator-valued measures. A quantitative notion of inaccuracy is defined. It is shown that within this framework joint inaccurate measurements are possible for arbitrary maximal projection-valued measures on finite-dimensional spaces. The accuracy of such measurements is limited, as is shown by an inaccuracy inequality we derive. This new type of uncertainty relation can be unambiguously interpreted as referring to measurement precision rather than preparative quality. Several recent (...) experiments are seen to be realizations of such joint measurements. (shrink)

To support healthcare professionals in dealing with ethically difficult situations, Clinical Ethics Support (CES) services like Moral Case Deliberation (MCD) are increasingly implemented. To assess the impact of CES, it is important to evaluate outcomes. Despite general claims about outcomes from MCD experts and some qualitative research, there exists no conceptual analysis of outcomes yet. Therefore, the aim of this study was to systematically define and categorize MCD outcomes. An additional aim was to compare these outcomes with the outcomes in (...) the Euro-MCD Instrument from 2014, to further validate this Instrument. The concept mapping method was used and involves qualitative and quantitative steps including brainstorming, individual structuring, computation of concept maps (by principal component analysis and cluster analysis), group interpretation and utilization. In total, 12 experienced MCD participants from a variety of professional backgrounds participated in two sessions. The focus group brainstorm resulted in a list of 85 possible MCD outcomes, of which a point map and concept maps were constructed. After a thorough discussion of each cluster, final consensus was reached on the names and position of 8 clusters of MCD outcomes: 1) Organisation and Policy; 2) Team development; 3) Personal development focused on the Other Person; 4) Personal development as Professional, focused on Skills; 5) Personal development as Professional, focused on Knowledge; 6) Personal development as an Individual; 7) Perception and Connection; and 8) Concrete action. This study explored and categorized MCD outcomes in a concept mapping focus group. When comparing the results with the Euro-MCD Instrument, our study confirms that outcomes of MCD can be categorized in clusters referring to the organisational level, team development, personal development (both as an individual and a professional) and the concrete case-level. In developing CES evaluation tools, it is important to be explicit if an outcome refers to the individual or the team, to knowledge or skills, to the organisation or the specific case. The findings will be used in the further validation of the Euro-MCD Instrument. The current study further contributes to the field of evaluating CES in general and defining outcomes of MCD in particular. (shrink)

Purpose The purpose of this paper is to develop an ethical framework for the marketing of corporate social responsibility. Methods The approach is a conceptual one based on virtue ethics and on the corporate identity literature. Furthermore, empirical research results are used to describe the opportunities and pitfalls of using marketing communication tools in the strategy of building a virtuous corporate brand. Results/conclusions An ethical framework that addresses the paradoxical relation between the consequentialist perspective many proponents of the marketing of (...) CSR adopt, and ethical perspectives which criticize an exclusive profit-oriented approach to CSR. Furthermore, three CSR strategies in relation to the marketing of CSR are discussed. For each CSR strategy it is explored how a corporation could avoid falling into the promise/performance gap. (shrink)

This paper analyses the concept of empirical ethics as well as three meta-ethical fallacies that empirical ethics is said to face: the is-ought problem, the naturalistic fallacy and violation of the fact-value distinction. Moreover, it answers the question of whether empirical ethics (necessarily) commits these three basic meta-ethical fallacies.

Background There has been little attention paid to research on the outcomes of clinical ethics support or critical reflection on what constitutes a good CES outcome. Understanding how CES users perceive the importance of CES outcomes can contribute to a better understanding, use of and normative reflection on CES outcomes. Objective To describe the perceptions of Dutch healthcare professionals on important outcomes of moral case deliberation, prior to MCD participation, and to compare results between respondents. Methods This mixed-methods study used (...) both the Euro-MCD instrument and semi-structured interviews. Healthcare professionals who were about to implement MCD were recruited from nursing homes, hospitals, psychiatry and mentally disabled care institutions. Results 331 healthcare professionals completed the Euro-MCD instrument, 13 healthcare professionals were interviewed. The outcomes perceived as most important were ‘more open communication’, ‘better mutual understanding’, ‘concrete actions’, ‘see the situation from different perspectives’, ‘consensus on how to manage the situation’ and ‘find more courses of action’. Interviewees also perceived improving quality of care, professionalism and the organization as important. Women, nurses, managers and professionals in mentally disabled care rated outcomes more highly than other respondents. Conclusions Dutch healthcare professionals perceived the MCD outcomes related to collaboration as most important. The empirical findings can contribute to shared ownership of MCD and a more specific use of MCD in different contexts. They can inform international comparative research on different CES types and contribute to normative discussions concerning CES outcomes. Future studies should reflect upon important MCD outcomes after having experienced MCD. (shrink)

Background: Moral case deliberation is a form of clinical ethics support to help healthcare professionals in dealing with ethically difficult situations. There is a lack of evidence about what outcomes healthcare professionals experience in daily practice after moral case deliberations. The Euro-MCD Instrument was developed to measure outcomes, based on the literature, a Delphi panel, and content validity testing. To examine relevance of items and adequateness of domains, a field study is needed. Aim: To describe experienced outcomes after participating in (...) a series of moral case deliberations, both during sessions and in daily practice, and to explore correlations between items to further validate the Euro-MCD Instrument. Methods: In Sweden, the Netherlands, and Norway, healthcare institutions that planned a series of moral case deliberations were invited. Closed responses were quantitatively analyzed. The factor structure of the instrument was tested using exploratory factor analyses. Ethical considerations: The study was approved in Sweden by a review board. In Norway and the Netherlands, data services and review boards were informed about the study. Results: The Euro-MCD Instrument was completed by 443 and 247 healthcare professionals after four and eight moral case deliberations, respectively. They experienced especially outcomes related to a better collaboration with co-workers and outcomes about individual moral reflexivity and attitude, both during sessions and in daily practice. Outcomes were experienced to a higher extent during sessions than in daily practice. The factor structure revealed four domains of outcomes, which did not confirm the six Euro-MCD domains. Conclusion: Field-testing the Euro-MCD Instrument showed the most frequently experienced outcomes and which outcomes correlated with each other. When revising the instrument, domains should be reconsidered, combined with theory about underlying concepts. In the future, a feasible and valid instrument will be presented to get insight into how moral case deliberation supports and improves healthcare. (shrink)

Introduction. Bert HAMMINGA and Neil DE MARCHI: Préface. Bert HAMMINGA and Neil DE MARCHI: Idealization and the Defence of Economics: Notes Toward a History. Part I: General Observations on Idealization in Economics. Kevin D. HOOVER: Six Queries about Idealization in an Empirical Context. Bernard WALLISER: Three Generalization Processes for Economic Models. Steven COOK and David HENDRY: The Theory of Reduction in Econometrics. Maarten C.W. JANSSEN: Economic Models and Their Applications. Adolfo GARCÍA DE LA SIENRA: Idealization and Empirical Adequacy (...) in Economic Theory. Izabella NOWAKOWA and Leszek NOWAK: On Correspondence between Economic Theories. Uskali MÄKI: Isolation, Idealization and Truth in Economics. Part II: Case Studies of Idealization in Economics. Nancy CARTWRIGHT: Mill and Menger: Ideal Elements and Stable Tendencies. Wolfgang BALZER: Exchange Versus Influence: A Case of Idealization. Kees COOLS, Bert HAMMINGA, Theo A.F. KUIPERS: Truth Approximation by Concretization in Capital Structure Theory. Daniel M. HAUSMAN: Paul Samuelson as Dr. Frankenstein: When an Idealization Runs Amuck. Hugo A. KEUZENKAMP: What if an Idealization is Problematic? The Case of the Homogeneity Condition in Consumer Demand. Werner DIEDERICH: Nowak on Explanation and Idealization in Marx's 'Capital'. Gérard JORLAND: Idealization and Transformation. Jack BIRNER: Idealizations and Theory Development in Economics. Some History and Logic of the Logic Discovery. Discussions. Leszek NOWAK: The Idealizational Methodology and Economics. Replies to Diederich, Hoover, Janssen, Jorland and Mäki. (shrink)

Background Decision-making competence is a complex concept in the care for transgender and gender diverse adolescents, since this type of care concerns one’s developing gender identity and involves treatment options that often lack international consensus. Even despite competence assessments, moral challenges arise in the decision-making process. Here, traditional forms of clinical ethics support such as moral case deliberation might not fit as these do not provide thematic guidance. This study therefore aimed to develop a practice-oriented ethics support tool to assist (...) care providers when dealing with moral challenges around decision-making competence in transgender adolescent care. Methods The study followed a participatory design to develop a tool in close collaboration with care providers; they had a say in all phases of development and dissemination. Firstly, nine care providers were interviewed about experienced moral challenges and needs for ethics support. Based on this, the structure and content of the tool was constructed and discussed in two focus group meetings, after which four care providers tested the tool and additional feedback was collected from the team and an advisory board. The final tool was presented to all Dutch care providers in transgender adolescent care. Results Care providers expressed a need for guidance in defining and assessing decision-making competence. Main moral challenges concerned discussing fertility options with young clients, dealing with co-occurring mental health difficulties and the decision-making role of parents. The final tool, named the Competence Consultant, is an interactive pdf containing four parts: (1) Clarify information; (2) Identify doubts and moral questions; (3) Guidance for conversations and (4) Overview and Conclusions. Discussion Developing an ethics support tool in a controversial care setting is highly relevant as it aims to help individual care providers in defining, discussing and dealing with their moral challenges in actual practice. The ‘Competence Consultant’ for transgender care providers contributes to their moral sensitivity and moral competence. It is an example of the development of innovative and integrative forms of thematic ethics support. (shrink)

This article discusses the ethical dimension of Sloterdijk's spherology and its contribution to the current debate on globalization. It is shown that Sloterdijk already developed the core of his ethics in his earlier works. The central distinction here is the ontological difference between the intimate stay of the fetus in its mother's womb and the ominous outside of the world. From its birth onwards the infant has to develop new intimate spheres to make life bearable and to expand into the (...) world. This coming into the world depends on the quality of macrospheres that take over the immunological functions of the microspheres. Sloterdijk believes that the current debate on globalization is a late and superficial reflection of the crisis of the metaphysical globalization. This crisis means that Europeans have lost their all-embracing macrosphere of the idealized globe. As a consequence, modernity means that people and cultures have to become more self-reliant to protect themselves from a radical outside. The actual globalization of the earth can therefore be understood as an ongoing exteriorization of the animated space of the local spheres. At the same time people from different cultures and states are forced to work together on an unprecedented scale. This actual globalization does not mean however, that there is a universal moral law that obliges us to put our self-interest aside in favour of the interests of strangers. In this respect Sloterdijk stresses the importance of care for one's own spheres, be it an individual, a family or a company, as a condition of responsibility and solidarity. (shrink)

According to the standards of public law, municipal polls have only a local scope : the election of a common council. Do politicians make deductions concerning the formal political power-constellation on national level either from the approach of municipal elections or from their results? Can these elections lead to changes in or of the government and eventually to anticipated legislative elections?After the first world-war, the electorate was called eight times to vote for new common councillors. Half of these elections had (...) no influence on the national power-constellation :they hardly stirred the national political life. In 1958 any possible influence of the municipal elections was even a priori ruled out. A remarkable point is that all municipal elections which took place undergovernments of national union, were only of local importance.Since the first world-war not a single municipal election has led to changes within the government : there was never a redistribution of ministerial portfolios amongst the coalitionpartners, nor did any electioncause the dismissal of an individual minister.It is traditional in Belgian politics that the national opposition, when the results of municipal elections are in its favour and prejudicial to the party in office, tries to call in question the legitimacy of the government in the opinion of the public by the way of motions or interpellations in parliament, claiming dismissal of the government or anticipated legislative elections. At these occasions it appeared unimportant whether the parliamental majority were confortable or not. But never did the governments give in to these attempts.The elections of 1857, 1884 and 1932 constitute an element of power - although of subsidiary importance - in the discharge of the then governments. The governmental crisis of 1884 however can only be explained if the constitutional position of Leopold II is taken into account. With all other factors alike, such a crisis wouldn't arise any more in the context of to-day. The municipal elections of 1932 have moreover led to anticipated legislative elections whose date was an element of power in the election-process. At that time, these elections played the part of an indicator of the electorial condition, comparable to that of the by elections in Great-Britain. And an unreliable indicator too, in view of the difference between national and local electionstatures. (shrink)

BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation (MCD). Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument (Euro-MCD) instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA North European (...) field survey among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.ResultsAll outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.ConclusionsThe findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such asmoralreflexivity andmoralattitude outcomes, should still be included. In the future, a combination of empirical findings (practice) and normative reflection (theories) will contribute to the revision of the instrument. (shrink)

This paper argues that historical research on late medieval and early modern craft guilds fails to escape teleological and anachronistic views, including when they are addressed as commons or ‘institutions for collective action’. These present-day conceptual lenses do not only create idealized views on guilds, but also of the contexts in which they operated, especially the state and the market. This is especially the case with neo-institutional views on the commons, which fall back on a transhistorical rational actor, who can (...) choose between three options for the allocation of resources and surpluses, namely the state, the market and the common. The paper shows that guilds were fundamentally entangled with both the state and the market and that their ethic implied a less utilitarian and instrumental attitude towards natural resources. The consequence of this is that the history of the guilds offers different lessons to present-day commoners than those implied by present-day research. With an eye at launching a reflection on that, I argue in favour of a cosmopolitical perspective, which invites to take fundamentally different worldviews seriously. This includes questioning our own conceptual and analytical abstractions like the state, the market and the individual, up to and including the very distinction between nature and society or nature and politics, which are at the very basis of modern science itself. (shrink)

BackgroundIn gender-affirming medical care (GAMC), ethical challenges in decision-making are ubiquitous. These challenges are becoming more pressing due to exponentially increasing referrals, politico-legal contestation, and divergent normative views regarding decisional roles and models. Little is known, however, about what ethical challenges related to decision-making healthcare professionals (HCPs) themselves face in their daily work in GAMC and how these relate to, for example, the subjective nature of Gender Incongruence (GI), the multidisciplinary character of GAMC and the role HCPs play in assessing (...) GI and eligibility for interventions. Given the relevance and urgency of these questions, we conducted a qualitative study among HCPs providing GAMC to transgender adults in the Netherlands.MethodsIn this qualitative research, we conducted 11 semi-structured interviews between May 2020 and February 2021 with HCPs (six mental health professionals, two HCPs in endocrinology, two in plastic surgery, and one in nursing) working in two distinct GAMC settings. We purposively sampled for professional background and years of experience in GAMC. We analyzed our interview data using thematic analysis. As some respondents were more inclined to speak about what should or ought to be done to arrive at good or right decision-making, we identified both ethical challenges and norms. Furthermore, in our analysis, we differentiated between respondents’ explicit and implicit ethical challenges and norms and ascertained the specific context in which these challenges emerged.ResultsRespondents’ ethical challenges and norms centered on (1) dividing and defining decisional roles and bounds, (2) negotiating decision-making in a (multidisciplinary) team, and (3) navigating various decision-making temporalities. These themes arose in the context of uncertainties regarding (1) GAMC’s guidelines, evidence, and outcomes, as well as (2) the boundaries and assessment of GI.ConclusionsThis interview study provides detailed empirical insight into both the explicit and implicit ethical challenges that HCPs experience and their ethical norms regarding decision-making. It also describes how uncertainties and (implicit) normativities concerning GAMC and GI pre-structure the moral environment in which these challenges and norms manifest. We provide normative reflections and recommendations on handling these ethical challenges in a way that is sensitive to the context in which they arise. (shrink)

Selecting a large and diverse sample of 5–6-year-old preschool children, we aimed to extend previous findings on variability in children’s home math environment and its association with children’s mathematical skills. We operationalized mathematics in a broader way than in previous studies, by considering not only children’s numerical skills but also their patterning skills as integral components of early mathematical development. We investigated the effects of children’s gender and socioeconomic status on their home math environment, examined the associations between children’s home (...) math environment and their mathematical skills, and verified whether these associations were moderated by children’s gender and/or SES. Parents of 353 children completed a home math environment questionnaire and all children completed measures of their numerical and patterning skills. Results indicated no effect of children’s gender on their home math environment. There was no effect of SES on the performed home math activities, but small SES differences existed in parents’ math-related expectations and their attitudes. We found no evidence for associations between children’s home math environment and their mathematical skills. Furthermore, there were no moderating effects of gender or SES on these associations. One explanation for these findings might relate to the characteristics of the general preschool system in the country of the present study. Future studies should consider the effect of the preschool learning environment because it might explain differences between studies and countries with regard to the home math environment and its association with mathematical skills. (shrink)

Abstract In the present article, we provide a critical overview of the emerging field of ‘neuroeducation’ also frequently referred to as ‘mind, brain and education’ or ‘educational neuroscience’. We describe the growing energy behind linking education and neuroscience in an effort to improve learning and instruction. We explore reasons behind such drives for interdisciplinary research. Reviewing some of the key advances in neuroscientific studies that have come to bear on neuroeducation, we discuss recent evidence on the brain circuits underlying reading, (...) mathematical abilities as well as the potential to use neuroscience to design training programs of neurocognitive functions, such as working memory, that are expected to have effects on overall brain function. Throughout this review we describe how such research can enrich our understanding of the acquisition of academic skills. Furthermore, we discuss the potential for modern brain imaging methods to serve as diagnostic tools as well as measures of the effects of educational interventions. Throughout this discussion, we draw attention to limitations of the available evidence and propose future avenues for research. We also discuss the challenges that face this growing discipline. Specifically, we draw attention to unrealistic expectations for the immediate impact of neuroscience on education, methodological difficulties, and lack of interdisciplinary training, which results in poor communication between educators and neuroscientists. We point out that there should be bi-directional and reciprocal interactions between both disciplines of neuroscience and education, in which research originating from each of these traditions is considered to be compelling in its own right. While there are many obstacles that lie in the way of a productive field of neuroeducation, we contend that there is much reason to be optimistic and that the groundwork has been laid to advance this field in earnest. Content Type Journal Article Category Original Paper Pages 1-13 DOI 10.1007/s12152-011-9119-3 Authors Daniel Ansari, Numerical Cognition Laboratory, Department of Psychology, The University of Western Ontario, Westminster Hall, London, ON N6A 3K7, Canada Bert De Smedt, Parenting and Special Education Research Group, Katholieke Universiteit Leuven, Leuven, Belgium Roland H. Grabner, Institute for Behavioral Sciences, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland Journal Neuroethics Online ISSN 1874-5504 Print ISSN 1874-5490. (shrink)

In latter-day discussions on corporate morality, duties of commission are fiercely debated. Moral institutionalists argue that duties of commission—such as a duty of assistance—overstep the boundaries of moral duty owed by economic agents. " Moral institutionalism" is a newly coined term for a familiar position on market morality. It maintains that market morality ought to be restricted, excluding all duties of commission. Neo-Classical thinkers such as Baumol and Homann defend it most eloquently. They underpin their position with concerns that go (...) to the core of liberalism—the dominant western political theory that sustains the ideals of both the free market and the free, rational person. Those authors claim that liberalism calls for a fully differentiated market because it resents the politicization of the market. Fully differentiated markets exclude duties of commission. They also claim that full differentiation of the market closes the troublesome gap between moral motivation and moral virtue. Full differentiation redeems the promise of "easy virtue". In this paper moral institutionalism will be rejected from a Kantian point of view, mostly inspired by Herman's thesis on the invisibility of morality. Liberalism may perhaps ban the politicization of the market; it does not forbid its moralization. The idea of a fully differentiated market must also be rejected because it is either morally over-demanding (to the morally autonomous person) or morally hazardous (to the person with failing moral motivation). Contrary to what the moral institutionalists claim, right action, morally, is actually quite difficult in fully differentiated markets. (shrink)

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

We very much welcome Enck and Condley’s (2025) introduction of agent-regret and their plea for the existential and moral importance of this concept as a distinct phenomenon from moral distress or c...

This paper analyses the use of strategies and instruments for organising ethics by small and large business in the Netherlands. We find that large firms mostly prefer an integrity strategy to foster ethical behaviour in the organisation, whereas small enterprises prefer a dialogue strategy. Both large and small firms make least use of a compliance strategy that focuses on controlling and sanctioning the ethical behaviour of workers. The size of the business is found to have a positive impact on the (...) use of several instruments, like code of conduct, ISO certification, social reporting, social handbook and confidential person. Also being a subsidiary of a larger firm has a significant positive influence on the use of instruments. The most popular instrument used by small firms is to let one member of the board be answerable for ethical questions, which fits the informal culture of most small firms. With respect to sectorial differences, we find that firms in the metal manufacturing and construction sectors are more actively using formal instruments than firms in the financial service sector and retail sector. The distinction between family and non-family firms hardly affects the use of instruments. (shrink)

The study of complexity in chronic care is an emergent discipline that has not yet developed a consistent theoretical framework. Thinking in the field of complexity encompasses complexity science and complexity theories, which represent a convergence of different types of ideas and theories that focus on the interactions of individual parts that make up a complex system. In this context, an important distinction is to be made between "complex" and "complicated." If a system—despite the fact that it may consist of (...) a huge number of components— can be given a complete description in terms of its individual constituents, such a system is merely complicated. An example could be computers. In a complex system, on the .. (shrink)

Starting from MacIntyre’s virtue ethics, we investigate several codes of conduct of banks to identify the type of virtues that are needed to realize their mission. Based on this analysis, we define three core virtues: honesty, due care, and accuracy. We compare and contrast these codes of conduct with the actual behavior of banks that led to the credit crisis and find that in some cases banks did not behave according to the moral standards they set themselves. However, although banks (...) and the professionals working in them can be blamed for what they did, one should also acknowledge that the institutional context of the free market economy in which they operated made it difficult to live up to the core values lying at the basis of the codes of conduct. Given the neo-liberal free market system, innovative and risky strategies to enhance profits are considered desirable for the sake of shareholder’s interests. A return to the core virtues in the financial sector will therefore only succeed if a renewed sense of responsibility in the sector is supported by institutional changes that allow banks to put their mission into practice. (shrink)

Background: Patient participation in clinical ethics support services has been marked as an important issue. There seems to be a wide variety of practices globally, but extensive theoretical or empirical studies on the matter are missing. Scarce publications indicate that, in Europe, patient participation in CESS varies from region to region, and per type of support. Practices vary from being non-existent, to patients being a full conversation partner. This contrasts with North America, where PP seems more or less standard. While (...) PP seems to be on the rise in Europe, there is no data to confirm this. This study sought a deep understanding of both habits and the attitudes towards PP in the Netherlands, including respondents’ practical and normative perspectives on the matter. Methods and Results: We developed a national survey on PP for Dutch CESS staff. Our survey comprised a total of 25 open and close-ended questions, focused on four topics related to PP goals of CESS, status quo of PP, ideas and ideals concerning PP, and obstacles for PP. Discussion: The four most important findings were that: Patient participation in Dutch CESS is far from standard. Views on patient participation are very much intertwined with the goals of ethics support. Hesitations, fears and perceived obstacles for PP were not on principle and Most respondents see PP as a positive opportunity, yet requiring additional training, practical guidance and experience. Conclusions: Various normative reasons require PP. However, PP seems far from standard and somewhat rare in Dutch CESS settings. Our respondents did not raise many principled objections to PP. Instead, reasons for the lack of PP are intertwined with viewpoints on the goals of CESS, which seemingly focus on supporting health care professionals. Training and practical guidance was thought to be helpful for gaining experience for both CESS staff and HCPs. (shrink)

Background The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit (...) staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support. Methods A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement. Results All 178 respondents (response rate: 25–32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to ‘team cooperation’, ‘team solidarity’ and ‘work ethic’. Lessons learned were mostly related to ‘quality of care’ and ‘professional qualities’. Conclusions Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals’ dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience. Trial registration The trial was registered on The Netherlands Trial Register, number NL9177. (shrink)

Practical implementation of notions such as patient-orientation, client-centredness, and demand-driven care is far from straightforward in care and service supply to elderly clients living independently. This paper aims to provide preliminary insights into how it is possible to bridge the gap between policy intent, which reflects an increasing client orientation, and actual practice of care and service provision. Differences in personal objectives and characteristics generate different sets of needs among elderly clients that must have an appropriate response in the daily (...) routines of care and service providers. From a study of the available literature and by conceptual reasoning, we identify several important operational implications of client-oriented care and service provision. To deal with these implications the authors turn to the field of operations management. This field has deepened the understanding of translating an organisation’s policy into daily activities and working methods. More specifically, we elaborate on the concept of modularity, which stems from the field of operations management. With respect to elderly people who live independently, this concept, among others, seems to be particularly useful in providing options and variation in individual care and service packages. Based on our line of reasoning, we propose that modularity provides possibilities to enhance the provision of demand-based care and services. Furthermore, our findings offer direction on how organisations in housing, welfare and care can be guided in translating demand-based care to their operational processes. (shrink)