Deliberative ways of dealing with ethical issues in health care are expanding. Moral case deliberation is an example, providing group-wise, structured reflection on dilemmas from practice. Although moral case deliberation is well described in literature, aims and results of moral case deliberation sessions are unknown. This research shows (a) why managers introduce moral case deliberation and (b) what moral case deliberation participants experience as moral case deliberation results. A responsive evaluation was conducted, explicating moral case deliberation experiences by analysing aims (...) (N = 78) and harvest (N = 255). A naturalistic data collection included interviews with managers and evaluation questionnaires of moral case deliberation participants (nurses). From the analysis, moral case deliberation appeals for cooperation, team bonding, critical attitude towards routines and nurses’ empowerment. Differences are that managers aim to foster identity of the nursing profession, whereas nurses emphasize learning processes and understanding perspectives. We conclude that moral case deliberation influences team cooperation that cannot be controlled with traditional management tools, but requires time and dialogue. Exchanging aims and harvest between manager and team could result in co-creating (moral) practice in which improvements for daily cooperation result from bringing together perspectives of managers and team members. (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)

Over the past decades, great strides have been made to professionalize and increase access to transgender medicine. As the evidence base grows and conceptualizations regarding gender dysphoria/gender incongruence evolve, so too do ideas regarding what constitutes good treatment and decision-making in transgender healthcare. Against this background, differing care models arose, including the ‘Standards of Care’ and the so-called ‘Informed Consent Model’. In these care models, ethical notions and principles such as ‘decision-making’ and ‘autonomy’ are often referred to, but left unsubstantiated. (...) This not only transpires into the consultation room where stakeholders are confronted with many different ethical challenges in decision-making, but also hampers a more explicit discussion of what good decision-making in transgender medicine should be comprised of. The aim of this paper is to make explicit the conceptual and normative assumptions regarding decision-making and client autonomy underpinning the ‘Standards of Care’ and ‘Informed Consent Model’ currently used in transgender care. Furthermore, we illustrate how this elucidation aids in better understanding stakeholders’ ethical challenges related to decision-making. Our ethical analysis lays bare how distinct normative ambiguities in both care models influence decision-making in practice and how foregrounding one normative model for decision-making is no moral panacea. We suggest that the first steps towards good decision-making in gender-affirming medical care are the acknowledgement of its inherent normative and moral dimensions and a shared, dialogical approach towards the decision-making process. (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)

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)

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)

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and (...) products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes. (shrink)

Ecological developmental biology (eco‐devo) explores the mechanistic relationships between the processes of individual development and environmental factors. Recent studies imply that some of these relationships have deep evolutionary origins, and may even pre‐date the divergences of the simplest extant animals, including cnidarians and sponges. Development of these early diverging metazoans is often sensitive to environmental factors, and these interactions occur in the context of conserved signaling pathways and mechanisms of tissue homeostasis whose detailed molecular logic remain elusive. Efficient methods for (...) transgenesis in cnidarians together with the ease of experimental manipulation in cnidarians and sponges make them ideal models for understanding causal relationships between environmental factors and developmental mechanisms. Here, we identify major questions at the interface between animal evolution and development and outline a road map for research aimed at identifying the mechanisms that link environmental factors to developmental mechanisms in early diverging metazoans.Also watch the Video Abstract. (shrink)

La 4e de couverture indique : "Avec l'accélération de la mondialisation, une opinion qui aurait, jusqu'il y a peu, été taxée d'incongruité, semble avoir gagné le statut d'évidence : le système étatique mondial serait menacé et appellerait à une profonde redéfinition des attributs, des structures et du rôle traditionnellement dévolus aux Etats. Malgré un échiquier géopolitique modifié, où les frontières s'évanouissent et où les cultures et les traditions nationales s'amalgament jusqu'à l'extinction, il faut cependant reconnaître que la mondialisation n'est pas (...) venue à bout des Etats, des sociétés qui les composent et des divers problèmes que crée la cohabitation au sein de leurs institutions traditionnelles. Bien au contraire, la mondialisation a souvent contribué à enclencher en série des situations qui se répercutent sur les plans social et étatique. Dans toutes ces situations, c'est aux Etats, à leur gouvernement et à la société entière qu'il appartient de restaurer, voire de réinventer, la trame des communautés politiques. Non pas en érigeant des barrages à la mondialisation, mais en contribuant à la création des institutions d'une gouvernance globale juste et efficace. Rassemblant des collaborateurs de l'Europe, du Québec, du Canada anglais et des Etats-Unis, ce livre questionne, sous des angles différents, la pertinence théorique de la notion de communauté politique lorsqu'il s'agit de penser le pluralisme résultant de l'immigration internationale. II pose aussi un regard critique sur le rôle que cette notion joue dans les approches courantes des phénomènes liés à la diversité. Car plusieurs questions se posent maintenant, dont celle, au premier chef, de la capacité des appareils d'Etats contemporains de cimenter des communautés politiques dans un contexte de mobilité spatiale accrue et de transnationalisme croissant.". (shrink)

Dans des études diachroniques et synchroniques récentes, on constate une convergence vers l’idée que l’analyse de des fonctionnant comme article (« article-like » des, désormais desal) ne doit pas être fondée sur une relation avec les partitifs. Cette contribution reprend ce débat et montrera que les approches proposées pour contourner une analyse partitive de desal entraînent pourtant un certain nombre de défis. L’identification de ces défis nous mène à élargir notre perspective vers les partitifs nus (c’est-à-dire des structures partitives sans (...) déterminant « upstairs », p. ex. de ces N) en français, italien et néerlandais. Surtout cette dernière langue est particulièrement intéressante, vu que les partitifs nus ne s’y sont pas fossilisés. Sur la base de ces données, nous proposerons une analyse de desal comme faisant partie de la famille des partitifs nus. Cette approche partitive de desa, qui rend compte de faits synchroniques et diachroniques, s’avère théoriquement plus élégante et a une couverture empirique plus large. (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)

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)

BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES (...) practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions.ResultsThe main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices.ConclusionsThe evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA. (shrink)

L’histoire récente des sciences humaines et sociales commence à prendre en considération la question des représentations de la vie savante par les savants eux mêmes, comme de la manière dont il parle et commente leur propre travail de recherche. Georges Dumézil donne à voir un parcours très intéressant, faits de multiples repentirs et tâtonnements que Dumézil intégra au cœur de sa méthode comparative.

4e de couv.: Les écrits de Michel Foucault sont stratifiés, hiérarchisés, entre les livres, les entretiens et les cours au Collège de France, mais ils sont surtout disséminés dans leurs usages. Désormais, et en plus de l'histoire des sciences et de la philosophie, les "effets" Foucault sont palpables sur la théorie de la littérature et du cinéma, l'histoire culturelle et sociale, les théories du genre, la pensée politique, les sciences de gestion, etc. C'est dans ce chantier ouvert que se situe (...) cet ouvrage. Il s'agit pour Jérôme Lamy, Jean-François Bert et leur équipe de spécialistes de resituer et d'analyser une pensée empruntant des questionnements à d'autres champs, de la psychologie à l'économie, de la science politique à la géographie, tout en ne se réclamant pas de ces sciences humaines et sociales. Pour comprendre la position de Foucault, les grands axes méthodologiques qu'il a parcourus sont retracés, telle l'archéologie, l'épistémè, la problématisation. Les concepts, des ouvrages maintenant classiques aux cours et à l'histoire de la sexualité, sont également revisités. Cette lecture critique des écrits et des usages de Foucault permet de le confronter aux analyses les plus récentes en sciences sociales, comme les postcolonial studies, ou de suivre les dialogues engagés (parfois à distance) avec des auteurs comme Norbert Elias, Michel de Certeau et Pierre Bourdieu. Un inventaire aussi rigoureux qu'éclairant. (shrink)

H. et M. van Effenterre présentent un décret inédit des environs de 500 av. J.-C. interdisant l'accueil des étrangers dans la cité de Lyttos qui avait été découvert par N. Platon. Ils en étudient l'alphabet, le dialecte et la syntaxe, et le rapport avec la xénèlasia et la dikè exoulès. Ils y reconnaîtraient la méfiance de la cité contre des rapatriés parmi lesquels l'aristocratie des cosmes chercherait une clientèle, en particulier une main-d'œuvre nécessaire au développement de l'élevage. En effet, un (...) second décret, au verso du document, définit le lieu de rassemblement fixé pour les troupeaux communautaires. Mention est faite des Itaniens et du lieu-dit Dèt(alla) où l'on devrait peut-être retrouver le plateau du Lassithi. Nombreux hapax. (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)

AimThe neurocognitive basis of Developmental Coordination Disorder remains an issue of continued debate. This combined systematic review and meta-analysis provides a synthesis of recent experimental studies on the motor control, cognitive, and neural underpinnings of DCD.MethodsThe review included all published work conducted since September 2016 and up to April 2021. One-hundred papers with a DCD-Control comparison were included, with 1,374 effect sizes entered into a multi-level meta-analysis.ResultsThe most profound deficits were shown in: voluntary gaze control during movement; cognitive-motor integration; practice-/context-dependent (...) motor learning; internal modeling; more variable movement kinematics/kinetics; larger safety margins when locomoting, and atypical neural structure and function across sensori-motor and prefrontal regions.InterpretationTaken together, these results on DCD suggest fundamental deficits in visual-motor mapping and cognitive-motor integration, and abnormal maturation of motor networks, but also areas of pragmatic compensation for motor control deficits. Implications for current theory, future research, and evidence-based practice are discussed.Systematic Review RegistrationPROSPERO, identifier: CRD42020185444. (shrink)

Background Clinical moral case deliberation consists of the systematic reflection on a concrete moral case␣by health care professionals. This paper presents the study of a 4-year moral deliberation project.Objectives The objectives of this paper are to: (a) describe the practice and the theoretical background of moral deliberation, (b) describe the moral deliberation project, (c) present the outcomes of␣the evaluation of the moral case deliberation sessions, and (d) present the implementation process.Methods The implementation process is both monitored and supported by an (...) interactive responsive evaluation design with: (a) in-depth interviews, (b) Maastricht evaluation questionnaires, (c) evaluation survey, and (d) ethnographic participant observation. In accordance with the theory of responsive evaluation, researchers acted both as evaluators and moderators (i.e. ethicists).Results Both qualitative and quantitative results showed that the moral case deliberations, the role of the ethics facilitator, and the train-the-facilitator program were regarded as useful and were evaluated as (very) positive. Health care professionals reported that they improved their moral competencies (i.e. knowledge, attitude and skills). However, the new trained facilitators lacked a clear organisational structure and felt overburdened with the implementation process. The paper ends with both practical and research suggestions for future moral deliberation projects. (shrink)

Berkeley’s ‘esse is percipi’ has been criticized for implying epistemological solipsism, the main argument being that different minds cannot harbor numerically one and the same idea. Similarly, C. J. Boström, the dominating Swedish philosopher in the nineteenth century, was early scorned because his principle of esse est percipi allegedly contradicts the simultaneous claim that two spirits can perceive the same thing under qualitatively different appearances. Whereas the criticism against Berkeley is here regarded as valid, it is argued that Boström successfully (...) defended himself by employing a dual concept of meaning, resembling Frege’s Sinn and Bedeutung some thirty years later, and by postulating an ontology that permits human minds to share in the divine ideas that constitute reality. (shrink)

Many of our categorization experiences are non-transitive. For some objects a, b and c, a and b can appear indistinguishable, and likewise b and c, but a and c can appear distinguishable. Many categories also appear to be smooth; transitions between cases are not experienced as sharp, but rather as continuous. These two features of our categorization experiences tend to be addressed separately. Moreover, many views model smoothness by making use of infinite degrees. This paper presents a methodological strategy that (...) shows how solving the transitivity problem first can thereby introduce explanatory resources that feed into an account of smoothness without having to make use of infinite degrees. (shrink)

A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into (...) moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded ‘grey zone articles’, in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients’ and caregivers’ views on ethical challenges, is presented. (shrink)

This article focuses on three scenarios in which residual biological materials are turned into research collections during the procedure of procuring these materials for diagnostic, therapeutic or other non-research purposes. These three scenarios differ from each other primarily because they employ different models of consent: (a) precautionary consent, which may be secured during the collecting procedure; (b) the presumed consent model, which may be applied during the collection of materials; and (c) consent for research use of identifiable human biological materials, (...) which may be skipped entirely. These scenarios offer additional sources of biological samples for research purposes and at the same time seem to offer even more flexibility in terms of stringency of consent as compared with the more traditional models of broad consent in prospective research collections and the waiver of consent in retrospective research. Our discussion leads us to think that precautionary consent is preferable to presumed consent and no consent when handling issues of consent in the use of residual human biological materials for research. However, such precautionary consent should not be construed as blanket, unrestricted consent for any future use. (shrink)

Clarke and Beck discuss in their sections on congruency and confounds literature that has challenged the claim that the approximate number system represents numerical content. We argue that the propositions put forward by these studies aren't that far from the indirect model of number perception suggested by C&B.

Background Confidentiality is one of the central preconditions for clinical ethics support (CES). CES cases which generate moral questions for CES staff concerning (breaching) confidentiality of what has been discussed during CES can cause moral challenges. Currently, there seems to be no clear policy or guidance regarding how CES staff can or should deal with these moral challenges related to (not) breaching confidentiality within CES. Moral case deliberation is a specific kind of CES. Method Based on experiences and research into (...) MCD facilitators’ needs for ethics support in this regard, we jointly developed an ethics support tool for MCD facilitators: the Confidentiality Compass. This paper describes the iterative developmental process, including our theoretical viewpoints and reflections on characteristics of CES tools in general. Results The content and goals of the ethics support tool, which contains four elements, is described. Part A is about providing information on the concept of confidentiality in MCD, part B is a moral compass with reflective questions, part C focuses on courses of action for careful handling of moral challenges related to confidentiality. Part D contains general lessons, best practices and tips for dealing with confidentiality in future cases. Conclusions This paper concludes with providing some lessons-learned related to developing ethics support tools and some reflections on issues of quality and normativity of ethics support tools. (shrink)

Although moral case deliberation (MCD) is evaluated positively as a form of clinical ethics support (CES), it has limitations. To address these limitations our research objective was to develop a thematic CES tool. In order to assess the philosophical characteristics of a CES tool based on MCDs, we drew on hermeneutic ethics and pragmatism. We distinguished four core characteristics of a CES tool: (a) focusing on an actual situation that is experienced as morally challenging by the user; (b) stimulating moral (...) inquiry into the moral concepts, questions and routines in the lived experience of the CES tool user; (c) stimulating moral learning by exploring other perspectives; and (d) incorporating contextual details. We provide an example of a CES tool developed for moral dilemmas over client autonomy. Our article ends with some reflections on the normativity of the CES tool, other application areas and the importance of evaluation studies of CES tools. (shrink)

Did the September 11, 2001 terrorist attacks on the U.S. cause the values of teenagers in the U.S. to change? Did their previously important self-esteem and self-actualization values become less important and their survival and safety values become more important? Changes in the values of teenagers are important for practitioners, managers, marketers, and researchers to understand because high school students are our current and future employees, managers, and customers, and research has shown that values impact work and consumer-related attitudes and (...) behaviors. Further, studies that compared higher to lower performing for-profit and not-for-profit companies have found that higher performing organizations had strong values that permeated their organizations [Collins J. C., and J. I. Porras: 1994, Built to Last: Successful Habits of Visionary Companies (New York, Harper Business); O’Reilly, C. A. and J. A. Chatman: 1996, in B. M. Staw and L. L. Cummings (eds.), Research in Organizational Behavior, vol. 18 (JAI Press, Greenwhich, CT), pp. 157–200; O’Reilly, C. A.: 1989, California Management Review 31(4), 9–25; Posner, B. Z., and W. H. Schmidt: 1996, Public Personnel Management, 25(3), 277–298; Rousseau, D.: 1990, Group and Organization Studies 15(4), 448–460; Schein, E. H.: 2004, Organizational Culture and Leadership. San Francisco, Jossey Bass)]. While one study of adults found value changes, no known studies have explored if the values of teenagers also changed post-9/11. This study filled that research gap by exploring the values of a random sample of 1000 U.S. teenagers in grades 9 to 12 pre- and post-9/11, using a demographic questionnaire and the Rokeach Value Survey. The research results indicated that teenage survival, safety, and security values (a world at peace, freedom, national security, and salvation) increased in importance while their self-esteem and self-actualization values (a sense of accomplishment, inner harmony, pleasure, self-respect, and wisdom) decreased in importance, mirroring the changes for adults. The meaning of these findings for practitioners, managers, marketers and researchers was discussed. (shrink)

Regular polysemes are sets of ambiguous words that all share the same relationship between their meanings, such as CHICKEN and LOBSTER both referring to an animal or its meat. To probe how a distributional semantic model, here exemplified by bidirectional encoder representations from transformers (BERT), represents regular polysemy, we analyzed whether its embeddings support answering sense analogy questions similar to “is the mapping between CHICKEN (as an animal) and CHICKEN (as a meat) similar to that which maps between LOBSTER (...) (as an animal) to LOBSTER (as a meat)?” We did so using the LRcos model, which combines a logistic regression classifier of different categories (e.g., animal vs. meat) with a measure of cosine similarity. We found that (a) the model was sensitive to the shared structure within a given regular relationship; (b) the shared structure varies across different regular relationships (e.g., animal/meat vs. location/organization), potentially reflective of a “regularity continuum;” (c) some high-order latent structure is shared across different regular relationships, suggestive of a similar latent structure across different types of relationships; and (d) there is a lack of evidence for the aforementioned effects being explained by meaning overlap. Lastly, we found that both components of the LRcos model made important contributions to accurate responding and that a variation of this method could yield an accuracy boost of 10% in answering sense analogy questions. These findings enrich previous theoretical work on regular polysemy with a computationally explicit theory and methods, and provide evidence for an important organizational principle for the mental lexicon and the broader conceptual knowledge system. (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...

Contents: Foreword. Wolfgang BALZER and C. ULISES MOULINES: Introduction. José A. DÍEZ CALZADA: Structuralist Analysis of Theories of Fundamental Measurement. Adolfo GARCÍA DE LA SIENRA and Pedro REYES: The Theory of Finite Games in Extensive Form. Hans Joachim BURSCHEID und Horst STRUVE: The Theory of Stochastic Fairness - its Historical Development, Formulation and Justification. Wolfgang BALZER and Richard MATTESSICH: Formalizing the Basis of Accounting. Werner DIEDERICH: A Reconstruction of Marxian Economics. Bert HAMMINGA and Wolfgang BALZER: The Basic Structure of (...) Neoclassical General Equilibrium Theory. Klaus MANHART: Balance Theories: Two Reconstructions and the Problem of Intended Applications. Rainer WESTERMANN: Festinger's Theory of Cognitive Dissonance: A Structuralist Theory-Net. Rainer REISENZEIN: Wundt's Three-Dimensional Theory of Emotion. Pablo LORENZANO: Classical Genetics and the Theory-Net of Genetics. Hinne HETTEMA and Theo A.F. KUIPERS: The Formalisation of the Periodic Table. C. ULISES MOULINES: The Basic Core of Simple Equilibrium Thermodynamics. Thomas BARTELBORTH: An Axiomatization of Classical Electrodynamics. Author's Index. Subject Index. (shrink)

The central theme of this book is the question, Why do scientists pursue scientific investigation? Of course, Bert Theunissen begins by pointing out that the answers scientists offer will be socially acceptable answers. Even so, Theunissen asserts, the historian may infer from the answers what motivated the persons questioned. Moreover, insights may be gleaned concerning science, society, and the relations between the two in the period the scientists lived.In this book the author discusses the notions of the objective of (...) science endorsed, respectively, by Jan Hendrik van Swinden , Jan van der Hoeven , Pieter Harting , Gerrit Jan Moll , Franciscus C. Donders , Hugo de Vries , Martinus W. Beijerinck , and Hendrik Antoon Lorentz .From this list of names it appears that Theunissen has focused his study on the nineteenth century. That period is especially interesting with respect to the changing images of science, as the ideas of the main goal of the university altered completely during that period. At the beginning of the century providing an academic education was seen as the prime task. Research was not seen as part of the duties of a professor at all. Those that did any experimentation chose to do so for their own sake, not because it was an element of the curriculum. That had changed completely by the end of the century. By then scientific investigation was considered a regular—in fact the most important—task of the university. This change in focus went hand in hand with the establishment of a number of new laboratories for most Dutch universities.In the accounts of the above‐mentioned men the content and development of their ideas about the pursuit of science are examined. From this analysis the common element that emerges in their images of science is gain for society, as expressed in the title, which translates into English as something like “Profit and more profit.” In the view of these men the pursuit of science is profitable for society; it is not pursued just for its own sake, let alone for the pleasure of the pursuer. In the beginning of the century the well‐trained minds of an intellectual elite that had completed academic training was regarded as the prime benefit for society. By the end of the century the profit was understood to come from scientific investigation of nature: science was seen as an instrument to further human welfare.Initially, I found it surprising that each and every one of the leading persons confidently asserts that the pursuit of science is for the benefit of society at large. Yet, on closer inspection, that was not so surprising, as Theunissen has studied and quotes almost exclusively from published sources, from treatises written for fellow scholars, for administrators, and for the lay public. The author seems not to have studied correspondence or other private papers in which a man may have voiced less elevated purposes for the pursuit of science.One thing amazed me: in the whole of this work, covering over a hundred years of discussion and the ideas of some 300 Dutch scholars on the subject at hand, there is not one woman mentioned. Admittedly, by the time the present story finishes, in the early twentieth century, only a few women had been appointed to academic positions in Dutch universities, so there is presumably not much material to draw on. However, one argument in the debate raging in the last quarter of the nineteenth century about the admission of women to the universities was the view that women, like men, should have the benefit of a higher education so as to fully develop their minds.Most of the contents of this book have appeared in print already in the form of separate articles in various journals, some in English but mostly in the Dutch language. Presumably that explains why the author has chosen to publish his treatise in Dutch rather than English. Even though the author has stressed the national character of his exposé by discussing at length some controversies among Dutch historians of science on points he addresses, the issues considered in this book and the scope of the inquiry warrant international notice and discussion.This book has a pleasantly unpretentious layout and typography and is, moreover, very carefully produced: I have seen but one printing error—which I leave it to you to discover. (shrink)

On the occasion of the 50th anniversary of C. S. Lewis’s death, a special annotated edition of his Christian classic, The Screwtape Letters, with notes and excerpts from his other works that help illuminate this diabolical masterpiece. Since its publication in 1942, The Screwtape Letters has sold millions of copies worldwide and is recognized as a milestone in the history of popular theology. A masterpiece of satire, it offers a sly and ironic portrayal of human life and foibles from the (...) vantage point of Screwtape, a highly placed assistant to “Our Father Below.” At once wildly comic, deadly serious, and strikingly original, The Screwtape Letters comprises the correspondence of the worldly-wise devil Screwtape and his nephew Wormwood, a novice demon in charge of securing the damnation of an ordinary young man. For the first time, The Screwtape Letters will be presented in full-text accompanied by helpful annotations in a striking two-color format. These annotations will give fans a deeper, more nuanced understanding of the popular book, providing background information, explanations of terms, historical significance, and excerpts from Lewis’s other works that more fully explain the ideas in this volume. For both expert Lewis fans and casual readers, The Screwtape Letters: Annotated Edition will be a beautiful and insightful guide to a beloved classic. (shrink)

Contents: Foreword. Wolfgang BALZER and C. ULISES MOULINES: Introduction. José A. DÍEZ CALZADA: Structuralist Analysis of Theories of Fundamental Measurement. Adolfo GARCÍA DE LA SIENRA and Pedro REYES: The Theory of Finite Games in Extensive Form. Hans Joachim BURSCHEID und Horst STRUVE: The Theory of Stochastic Fairness - its Historical Development, Formulation and Justification. Wolfgang BALZER and Richard MATTESSICH: Formalizing the Basis of Accounting. Werner DIEDERICH: A Reconstruction of Marxian Economics. Bert HAMMINGA and Wolfgang BALZER: The Basic Structure of (...) Neoclassical General Equilibrium Theory. Klaus MANHART: Balance Theories: Two Reconstructions and the Problem of Intended Applications. Rainer WESTERMANN: Festinger's Theory of Cognitive Dissonance: A Structuralist Theory-Net. Rainer REISENZEIN: Wundt's Three-Dimensional Theory of Emotion. Pablo LORENZANO: Classical Genetics and the Theory-Net of Genetics. Hinne HETTEMA and Theo A.F. KUIPERS: The Formalisation of the Periodic Table. C. ULISES MOULINES: The Basic Core of Simple Equilibrium Thermodynamics. Thomas BARTELBORTH: An Axiomatization of Classical Electrodynamics. Author's Index. Subject Index. (shrink)

The Holocaust marks a decisive moment in modern suffering in which it becomes almost impossible to find meaning or redemption in the experience. In this study, C. Fred Alford offers a new and thoughtful examination of the experience of suffering. Moving from the Book of Job, an account of meaningful suffering in a God-drenched world, to the work of Primo Levi, who attempted to find meaning in the Holocaust through absolute clarity of insight, he concludes that neither strategy works well (...) in today's world. More effective are the day-to-day coping practices of some survivors. Drawing on testimonies of survivors from the Fortunoff Video Archives, Alford also applies the work of Julia Kristeva and the psychoanalyst Donald Winnicot to his examination of a topic that has been and continues to be central to human experience. (shrink)