BackgroundClinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies (...) and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process.MethodsThe revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes.ResultsThe Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. ‘now’) instead of an assumed improvement over time (e.g. ‘better’) and we omitted the question about perceived importance.ConclusionsThe Euro-MCD 2.0 is shorter, less complex and more strongly substantiated by an integration of empirical findings, theoretical reflections and dialogues with participants and experts. Use of the Euro-MCD 2.0 will facilitate evaluation of MCD and can thereby monitor and foster implementation and quality of MCD. The Euro-MCD 2.0 will strengthen future research on evaluation of outcomes of MCD. (shrink)

The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. (...) We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented. (shrink)

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

Bizarre delusions are not specific to schizophrenia and can be found in other psychotic disorders. However, to date, there are no studies investigating socio-demographic and clinical characteristics associated with BizD across the psychosis spectrum. In this study 819 subjects with a diagnosis of SZ, schizoaffective disorder and bipolar I disorder were included. Patients with history of BizD and with no BizD were compared with respect to socidemographic and clinical variables, and predictors of BizD were explored. Patients with BizD were less (...) educated, less likely to be married, had higher Positive and Negative Syndrome Scale negative scores and lower Young Mania Rating Scale scores. Younger age, SZ and SZA diagnoses, higher PANSS positive scores, presence of reference delusions, tactile and olfactory hallucinations were predictors. Our results indicate that BizD are associated with higher illness severity, lower functionality and specific set of symptoms. (shrink)

The legal requirements and justifications for collecting patient-identifiable data without patient consent were examined. The impetus for this arose from legal and ethical issues raised during the development of a population-based disease register. Numerous commentaries and case studies have been discussing the impact of the Data Protection Act 1998 and Caldicott principles of good practice on the uses of personal data. But uncertainty still remains about the legal requirements for processing patient-identifiable data without patient consent for research purposes. This is (...) largely owing to ignorance, or misunderstandings of the implications of the common law duty of confidentiality and section 60 of the Health and Social Care Act 2001. The common law duty of confidentiality states that patient-identifiable data should not be provided to third parties, regardless of compliance with the DPA1998. It is an obligation derived from case law, and is open to interpretation. Compliance with section 60 ensures that collection of patient-identifiable data without patient consent is lawful despite the duty of confidentiality. Fears regarding the duty of confidentiality have resulted in a common misconception that section 60 must be complied with. Although this is not the case, section 60 support does provide the most secure basis in law for collecting such data. Using our own experience in developing a disease register as a backdrop, this article will clarify the procedures, risks and potential costs of applying for section 60 support. (shrink)

Twenty-five essays originally published by Mead in various journals and now out-of-print books. This collection contains almost all of the philosophically significant writings of Mead which were published during his lifetime. Reck has written a fine introduction which relates the essays to Mead's posthumously published work and places his thought as a whole in historical perspective. This volume will be of interest both to philosophers and to students of social psychology.—G. A. C.

Ethics support services like Moral Case Deliberation intend to support healthcare professionals in ethically difficult situations. To assess outcomes of MCD, the Euro-MCD Instrument has been developed. Field studies to test this instrument are needed and have been conducted, examining important outcomes before MCD participation and experienced outcomes. The current study aimed to describe how participants’ perceive the importance of MCD outcomes after MCD; compare these perceptions with those before MCD participation; and test the factor structure of these outcomes. Swedish, (...) Norwegian and Dutch healthcare professionals rated the importance of outcomes in the Euro-MCD Instrument after four and eight MCDs. Ratings were compared with those before MCD participation using paired and independent samples t-tests. The factor structure was tested using exploratory factor analyses. After 4 and 8 MCDs, 443 respectively 247 respondents completed the instrument. More than 69% rated all MCD outcomes as ‘quite’ or ‘very’ important, especially outcomes from Enhanced Collaboration, Improved Moral Reflexivity and Improved Moral Attitude. Significant differences for 16 outcomes regarding ratings before and after MCD participation were not considered meaningful. Factor analyses suggested three categories, which seemingly resemble the domains Improved Moral Reflexivity, Enhanced Collaboration and a combination of Improved Moral Attitude and Enhanced Emotional Support. After participation in MCDs, respondents confirmed the importance of outcomes in the Euro-MCD Instrument. The question on perceived importance and the categorization of outcomes need reconsideration. The revised instrument will be presented elsewhere, based on all field studies and theoretical reflections. (shrink)

College students have become more representative as blood donors, mainly to help other people. This study ascertained the association between spirituality and adherence or intention to donate blood in post-graduate students. In this quantitative and cross-sectional study, participants were 281 students from a post-graduate programme at a Brazilian public university. After complying with ethical requirements, data were collected through a questionnaire for sociodemographic characterization and identification of blood donation practices, followed by the Spiritual Well-Being Scale. Descriptive statistics and parametric tests (...) were used for data analysis. A total of 74% of the participants were female and 26% were male. Previous experience and/or intention to donate blood were found in 75.3%; 14.3% donated blood periodically. In addition, 12.2% were not adept to donation and 12.5% were inapt. Spiritual Well-Being scores were similar between individuals who are not adept and those who donate periodically. In conclusion, in the sample, spirituality and blood donation are not associated, but spiritual well-being and gender are. To enhance blood donation, further research is needed. (shrink)

The classical and scholastic view of things was of neutral substance to which qualities were attached as substantial adjuncts. Qualities could apparently not be conceived of otherwise than as entities: blueness, hardness, pliability, toughness, translucency, and so on. Noun substantives were the part of speech by which they could most properly be referred to. The use of adjectives did not imply that these qualities were not substantival entities, but emphasized their subordinateness to the thing itself, and were useful in giving (...) pliability, lightness, and elegance to speech. But qualities could not be conceived of otherwise than as something superadded to the neutral substance which carried them. (shrink)

A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral case deliberation, healthcare professionals (...) bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation. (shrink)

Moral case deliberation (MCD) is a form of clinical ethics support in which the ethicist as facilitator aims at supporting professionals with a structured moral inquiry into their moral issues from practice. Cases often affect clients, however, their inclusion in MCD is not common. Client participation often raises questions concerning conditions for equal collaboration and good dialogue. Despite these questions, there is little empirical research regarding client participation in clinical ethics support in general and in MCD in particular. This article (...) aims at describing the experiences and processes of two MCD groups with client participation in a mental healthcare institution. A responsive evaluation was conducted examining stakeholders’ issues concerning client participation. Findings demonstrate that participation initially creates uneasiness. As routine builds up and client participants meet certain criteria, both clients and professionals start thinking beyond ‘us-them’ distinctions, and become more equal partners in dialogue. Still, sentiments of distrust and feelings of not being safe may reoccur. Client participation in MCD thus requires continuous reflection and alertness on relational dynamics and the quality of and conditions for dialogue. Participation puts the essentials of MCD (i.e., dialogue) to the test. Yet, the methodology and features of MCD offer an appropriate platform to introduce client participation in healthcare institutions. (shrink)

When Carl Jung and Carl Kerenyi got together to collaborate on this book, their aim was to elevate the study of mythology to a science. Kerenyi wrote on two of the most ubiquitous myths, the Divine Child and The Maiden, supporting the core 'stories' with both an introduction and a conclusion. Jung then provided a psychological analysis of both myths. He defined myth as a story about heroes interacting with the gods. Having long studied dreams and the subconscious, Jung identified (...) certain dream patterns common to everyone. These 'archetypes' have developed through the centuries, and enable modern people to react to situations in much the same way as our ancestors. From nuclear annihilation to AIDS and Ebola, we continue to engage the gods in battle. _Science of Mythology_ provides an account of the meaning and the purpose of mythic themes that is linked to modern life: the heroic battles between good and evil of yore are still played out, reflected in contemporary fears. (shrink)

“Tell me," Wittgenstein once asked a friend, "why do people always say, it was natural for man to assume that the sun went round the earth rather than that the earth was rotating?" His friend replied, "Well, obviously because it just looks as though the Sun is going round the Earth." Wittgenstein replied, "Well, what would it have looked like if it had looked as though the Earth was rotating?” What would it have looked like if we looked at all (...) sciences from the viewpoint of Wittgenstein’s philosophy? Wittgenstein is undoubtedly one of the most influential philosophers of the twentieth century. His complex body of work has been analysed by numerous scholars, from mathematicians and physicists, to philosophers, linguists, and beyond. This volume brings together some of his central perspectives as applied to the modern sciences and studies the influence they may have on the thought processes underlying science and on the world view it engenders. The contributions stem from leading scholars in philosophy, mathematics, physics, economics, psychology and human sciences; all of them have written in an accessible style that demands little specialist knowledge, whilst clearly portraying and discussing the deep issues at hand. (shrink)

In moral case deliberation (MCD), healthcare professionals meet to reflect upon their moral questions supported by a structured conversation method and non-directive conversation facilitator. An increasing number of Dutch healthcare institutions work with MCD to (1) deal with moral questions, (2) improve reflection skills, interdisciplinary cooperation and decision-making, and (3) develop policy. Despite positive evaluations of MCD, organization and implementation of MCD appears difficult, depending on individuals or external experts. Studies on MCD implementation processes have not yet been published. The (...) aim of this study is to describe MCD implementation processes from the perspective of nurses who co-organize MCD meetings, so called ‘ local coordinators ’. Various qualitative methods were used within the framework of a responsive evaluation research design. The results demonstrate that local coordinators work hard on the pragmatic implementation of MCD. They do not emphasize the ethical and normative underpinnings of MCD, but create organizational conditions to foster a learning process, engagement and continuity. Local coordinators indicate MCD needs firm back-up from management regulations. These pragmatic action-oriented implementation strategies are as important as ideological reasons for MCD implementation. Advocates of clinical ethics support should pro-actively facilitate these strategies for both practical and ethical reasons. (shrink)

College students have become more representative as blood donors, mainly to help other people. This study ascertained the association between spirituality and adherence or intention to donate blood in post-graduate students. In this quantitative and cross-sectional study, participants were 281 students from a post-graduate programme at a Brazilian public university. After complying with ethical requirements, data were collected through a questionnaire for sociodemographic characterization and identification of blood donation practices, followed by the Spiritual Well-Being Scale. Descriptive statistics and parametric tests (...) were used for data analysis. A total of 74% of the participants were female and 26% were male. Previous experience and/or intention to donate blood were found in 75.3%; 14.3% donated blood periodically. In addition, 12.2% were not adept to donation and 12.5% were inapt. Spiritual Well-Being scores were similar between individuals who are not adept and those who donate periodically. In conclusion, in the sample, spirituality and blood donation are not associated, but spiritual well-being and gender are. To enhance blood donation, further research is needed. (shrink)

We analyse a recent paper in which an alleged devastating criticism of the so called GRW proposal to account for the objectification of the properties of macroscopic systems has been presented and we show that the author has not taken into account the precise implications of the GRW theory. This fact makes his conclusions basically wrong. We also perform a survey of measurement theory aimed to focus better on the physical and the conceptual aspects of the so-called macro-objectification problem.

The usual representation of quantum algorithms is limited to the process of solving the problem. We extend it to the process of setting the problem. Bob, the problem setter, selects a problem-setting by the initial measurement. Alice, the problem solver, unitarily computes the corresponding solution and reads it by the final measurement. This simple extension creates a new perspective from which to see the quantum algorithm. First, it highlights the relevance of time-symmetric quantum mechanics to quantum computation: the problem-setting and (...) problem solution, in their quantum version, constitute pre- and post-selection, hence the process as a whole is bound to be affected by both boundary conditions. Second, it forces us to enter into relational quantum mechanics. There must be a representation of the quantum algorithm with respect to Bob, and another one with respect to Alice, from whom the outcome of the initial measurement, specifying the setting and thus the solution of the problem, must be concealed. Time-symmetrizing the quantum algorithm to take into account both boundary conditions leaves the representation to Bob unaltered. It shows that the representation to Alice is a sum over histories in each of which she remains shielded from the information coming to her from the initial measurement, not from that coming to her backwards in time from the final measurement. In retrospect, all is as if she knew in advance, before performing her problem-solving action, half of the information that specifies the solution of the problem she will read in the future and could use this information to reach the solution with fewer computation steps. This elucidates the quantum computational speedup in all the quantum algorithms examined. (shrink)

A brief review of the conceptual difficulties met by the quantum formalism is presented. The main attempts to overcome these difficulties are considered and their limitations are pointed out. A recent proposal based on the assumption of the occurrence of a specific type of wave function collapse is discussed and its consequences for the above-mentioned problems are analyzed.

Ethical difficulties arise in health-care practices. However, despite extensive research findings that demonstrate that most nurses are involved in recurrent ethical problems, institutions are not always able to effectively support nursing care professionals. The limited availability of ethics consultation services and traditional nursing training fails to meet the frequent and strong requests by health workers to support their ethical dilemmas. A questionnaire was administered to 374 nurses attending a specialist training and a lifetime learning programme in Italy. The respondents reported (...) a high frequency of ethically sensitive situations, and they described the poor development of ethics support and a scarcity of ethics training programmes. The results suggest the importance of promoting ethics services that include consultation and ethics training. A need for systematic ethics educational activities was identified for improving the capacity of nurses to manage ethical issues in patient care. (shrink)

Der hier erstmals ver]ffentlichte Briefwechsel zwischen dem Psychiater C.G. Jung und dem Nobelpreistr{ger der Physik Wolfgang Pauli ist ein geistesgeschichtliches Dokument ersten Ranges. Ein privates Schicksal hat sie zusammengef}hrt, und daraus ist ein vorwissenschaftlicher Dialog erwachsen, in dem versucht wird, naturwissenschaftliches und psychologischesDenken zu vereinheitlichen. Die Briefe verdeutlichen, da~ es weder f}r den Psychologen zul{ssig ist, die methodischen Einsichten der Physik, noch f}r den Physiker, die Erfahrungen im Umgang mit dem Psychischenzu vernachl{ssigen.