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)

The study examines gradation as a central mode of 18th century thought. Originally a structural notion in the natural sciences, gradation underwent a change in the 17th century to become a major descriptive trope for gradually intensifying patterns of change. As a trope that extends across disciplinary boundaries, gradation became an important aesthetic concept of the period in areas as diverse as rhetoric, aesthetics, dramatic art, and music."--Provided by publisher.

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)

Objetiva-se com este artigo uma breve investigação sobre a relação existente entre Fé e Razão, especificamente no que toca à compreensão do intellectus fidei e da ratio fidei enquanto desdobramento temático. De acordo com a Carta Encíclica Fides et Ratio, a Fé e a Razão se assemelham a duas asas com as quais o espírito humano se eleva à contemplação da verdade. O desejo de conhecimento da verdade e, por conseguinte, de Deus e de si próprio é apontado como uma (...) vocação divina colocada no coração do homem por Deus. Embora as questões de fé possam passar por um tratamento racional, a fé possui a sua inteligência própria, específica não se limitando a esquemas relativos à razão demonstrativa, científica ou discursiva. (shrink)

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)

Cette édition numérique a été réalisée à partir d'un support physique, parfois ancien, conservé au sein du dépôt légal de la Bibliothèque nationale de France, conformément à la loi n° 2012-287 du 1er mars 2012 relative à l'exploitation des Livres indisponibles du XXe siècle. L'histoire des hommes est l'histoire de leurs guerres, dit-on, la paix ne serait qu'une trêve préparant de nouveaux conflits. « Copyright Electre » Pages de début Avant-propos Introduction Première partie - La réalité de la guerre Présentation (...) 1 - La guerre, l'ordre du monde et l'ordre de Dieu 2 - Le désir et la guerre 3 - La nature, le destin et la guerre 4 - La liberté et la guerre Deuxième partie - Les utopies de la paix Présentation 1 - Conjecture sur la paix naturelle 2 - La paix originelle et la paix civile 3 - La paix perpétuelle Troisième partie - Vers la paix Présentation 1 - La faille ontologique 2 - Une ontologie oubliée 3 - Laparole et la paix Pages de fin. (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)

Des mortalités anormales frappent les ruchers d’Europe et d’autres continents depuis un peu plus de vingt ans. Depuis le début des troubles, des suspicions pèsent sur des insecticides d’un genre nouveau, utilisés en traitement de semences. La législation prescrivant l’évaluation des risques environnementaux de toute substance insecticide dès avant sa mise sur le marché, des apiculteurs sont allés consulter les dossiers portant sur les molécules suspectées, ce qui les a amenés à s’impliquer dans la critique et l’élaboration des règles d’évaluation, (...) et à côtoyer le monde des experts en toxicologie de l’abeille.Beehives across Europe and other continents have been affected by abnormal mortality for the last twenty years. Since these problems first appeared, suspicion has fallen on a new type of insecticide, which is used to treat seeds. The legislation prescribes environmental risk assessments of any insecticide substance before it reaches the market, and beekeepers therefore decided to consult the files concerning the suspect molecules. As a result, they became involved in critically reviewing and developing assessment rules, and thus came to rub shoulders with experts in bee toxicology. (shrink)

O artigo apresenta e analisa as representações acerca da espiritualidade presentes nos relatos de mulheres usuárias de substâncias que buscam acolhimento em comunidades terapêuticas (CTs) de perfil religioso. Os dados observados são provenientes de entrevistas semiestruturadas realizadas ao longo do segundo semestre de 2020 com mulheres acolhidas em duas CT’s, sendo uma delas de perfil católico carismático e outra vinculada a uma igreja que compõe o protestantismo histórico. As lideranças dessas instituições foram igualmente ouvidas com a intenção de alcançar informações (...) a respeito da maneira como religião e espiritualidade são acionadas e articuladas no método empregado por essas CTs. A principal conclusão desse trabalho indica que as estratégias institucionais aplicadas para afastar essas mulheres do uso de substâncias fundamentam-se em narrativas religiosas que, muitas vezes, são ressignificadas pelas acolhidas por meio de suas próprias experiências subjetivas ao longo da permanência na CT. Ainda, deve-se ressaltar que a espiritualidade vivenciada pelas entrevistadas parece, em algumas situações, confrontar as orientações institucionais. (shrink)

Que l’on s’attache à mettre en lumière une forme d’humanité chez l’abeille ou que l’on observe dans l’espèce humaine des comportements d’essaims, la volonté de rapprocher les deux espèces est coutumière et récurrente. Ne faut-il voir dans ces déclarations de proximités, cet intérêt et cette fascination pour l’abeille qu’anthropomorphisme simpliste, rêveries champêtres de poètes dominicaux ou fantaisies puériles nourries d’images d’Épinal et de dessins animés japonais ? Le rapprochement n’est ..

Koster investigates the subject of death and dying as depicted on Scandinavian runic stones from the Viking era. Her study calls into question our conventional understanding of the function of these inscriptions, showing that runic inscriptions were not limited to epigraphs, but were also prepared more generally for individuals who were still alive.".

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)

Qu’est-ce que le travail? La question posée par le titre de ce recueil offre un tremplin pour des réponses multiples et nuancées, fruits de recherches sur un large spectre temporel et spatial. Les articles qui le composent répondent à cette question en interrogeant la façon dont le genre définit notre compréhension du travail. Se trouvent donc placés au premier plan les problèmes relatifs à l’égalité, le rôle du marché versus l’espace privé, la question des capacités de production comparée a...

This study aims to map out the relationships that make up green innovation initiatives in Brazilian industry. The sample comprised 100 managers at manufacturing companies, most of them operating in the business of farm machinery and equipment and steel structures. To develop this study, Medeiros et al. study, mapping critical factors that drive the success of green product innovation and the paradigm of complexity, was used as a reference study. Based on the results, it was possible to identify that the (...) operational dynamic of the factors and variables that affect market success do not happen in an isolated or fragmented way; they occur systematically with different contingencies and structured basic and intermediate skills in order to meet the expectations of consumers, laws, and environmental legislation. Initially, the technological expertise factor was noted as very important for sustaining green product innovation. Furthermore, since proactive leaders are an important factor for successfully developing environmentally sustainable products, it must be added to technological expertise as the foundation for developing green innovation. After defining the basis for green product innovation, the intermediary conditions necessary for using the available technology appropriately were mapped out. In this sense, variables such as “elimination of cultural barriers,” “capacity for critical reflective analysis,” and “experimentation” are also very important. In addition, some of the variables of the cross-functional collaboration and market knowledge factors were a part of the structure that organizations need to transform potential into developing green products, which is the basis for the third level of the model. The fourth level of the model has the “meeting consumer expectations” and “following law and legislation” factors, which make up the main goals for developing environmentally sustainable products according to a number of surveys that were conducted. (shrink)

En prenant pour exemple mon parcours personnel allant du travail de la cure à celui de l’écriture, des violences politiques reflétées dans celles de la famille à la douleur de leurs inscriptions psychiques et textuelles, la première partie de l’exposé montrera en quoi le travail d’élaboration et d’écriture que doit effectuer un descendant de survivants, s’il cherche à psychiser, historiciser et inscrire le trauma de ses ascendants, constitue une démarche violente et transgressive. La seconde partie dégagera quelques aspects des déterminants (...) psychiques qui affectent les descendants de survivants : le caractère double du vécu traumatique, l’expérience d’une délocalisation psychique en l’absence d’image narcissisante, le souvenir de la terreur dans le rapport aux autres, la mutilation ou l’incapacité d’être. (shrink)

ZusammenfassungKreuzfahrtschiffe zählen gegenwärtig zu den beliebtesten und zugleich umstrittensten Verkehrsmitteln. Das überdimensionale Schiff vor der Kulisse des historischen Zentrums von Venedig wurde zu einem ikonischen Bild. Der Artikel beleuchtet den Hintergrund dieser Debatte und untersucht die Verräumlichung der Kreuzfahrtindustrie durch Infrastrukturen und ihre Auswirkungen auf Venedig und die Lagune aus kulturanalytischer Sicht, und nimmt die Schnittmenge von kulturwissenschaftlicher Technikforschung und Technikgeschichte, kulturwissenschaftlicher Stadtforschung und der Analyse sozialer Bewegungen in den Blick.In meinem Beitrag zeichne ich die Entwicklung dieser Zusammenhänge nach und (...) zeige, wie Aktivist:innen, Vereine und engagierte Bürger:innen diese Verflechtungen aufgreifen und performen. Der Protest machte das Schiff zu einem wirkmächtigen Symbol für die infrastrukturelle Aneignung und Umgestaltung natürlicher und städtischer Räume. Da Transport- und Verkehrswege stets den Alltag der Menschen beeinflussen, gilt es, ihre Auswirkungen auf Praktiken, Räume und Beziehungen zu berücksichtigen, besonders in einer Stadt wie Venedig, wo Fuß- und Wasserwege stark zur Identität der Stadt und ihrer Bewohner:innen beitragen. Durch die Aktionen, das implizite Wissen über lokale Räume und das explizite Wissen, das das Protestnetzwerk produziert, widersetzt es sich hegemonialen Diskursen und trägt zugleich zu diesen bei. Ich argumentiere, dass das Schiff zu einer Metapher des globalen Kapitalismus wurde und daher als Symbol mit transnationaler Wirkung fungiert. (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...

Given Kripke’s semantic views, a statement, such as ‘Water is H 2 O’, expresses a necessary a posteriori truth. Yet it seems that we can conceive that this statement could have been false; hence, it appears that we can conceive impossible states of affairs as holding. Kripke used a de dicto strategy and a de re strategy to address three illusions that arise with respect to necessary a posteriori truths: (1) the illusion that a statement such as ‘Water is H (...) 2 O’ possibly expresses a falsehood, (2) the illusion that conceivability can fail to latch on to a genuine metaphysical possibility, and (3) the illusion that one can access a real metaphysical possibility by conceiving that water is not H 2 O. In this paper I argue that while Kripke’s de dicto strategy dispels (1), his strategies do not enable him to dispel (2) and (3). (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)

This paper argues that in L’ Invitée and in The Second Sex, Black presence, especially “Black female presence,” functions as the fundamental field against which White female consciousnesses are able to make sense of themselves as subjects and objects in their relationships with Others, including when the Others are themselves. Considering The Second Sex and L’ Invitée as together providing Beauvoir’s understanding of gender allows for an account of how “Black female presence”—in the form of the White imaginary’s idea of (...) Black women—is present and operational in The Second Sex. (shrink)

Le présent article s’appuie sur une pratique psychologique dans le cadre de visites médiatisées. Il cible notamment les entretiens cliniques réalisés par le psychologue avec les parents dans l’après-coup des visites médiatisées et a pour objectif de saisir l’enjeu clinique de ces temps d’entretiens. Deux vignettes cliniques permettent d’esquisser les potentialités des rencontres en l’absence des enfants. Il apparaît que ces entretiens favorisent le rétablissement d’une activité de mentalisation et de symbolisation. Enfin, une discussion métapsychologique éclaire les études de cas.

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)

Teacher strikes have taken place in the United States since the end of the 19th century, became much more common in the 1960s, and have enjoyed a resurgence over the past five years (2018-2023). In this paper, we analyze teacher strikes with two main objectives. First, we examine how sexism and misogyny impact discourse around teacher strikes, as well as the justifications that teachers themselves give for striking. We find that teachers are at risk of being deemed ‘immoral’ unless they (...) justify their decision to strike by appealing to their being in the service of others. Pressure to adopt this framing not only negatively impacts teachers’ dignity as human beings deserving of adequate compensation and working conditions, but it also inadvertently upholds unjust patriarchal norms regarding teaching as care work. In the second part of this paper, we put forward alternative framings teachers can adopt in justifying their decisions to strike. The framings are rooted in philosophical literature that allows for self-regarding actions to be recognized as properly moral in certain circumstances. We argue that by extending this recognition to teachers who strike, we combat covert sexist expectations and uphold the dignity of teachers as persons. (shrink)

En France, parler d’argent est encore plus difficile que de parler de sexualité. À partir d’une enquête par histoires de vie, effectuée auprès de cent cinq hommes et femmes de tous âges, tous milieux et toutes régions, Janine Mossuz-Lavau montre comment se fait l’apprentissage de l’argent, quel est le poids des cultures familiales dans la formation des comportements à son égard, comment il pèse sur les couples, qu’ils perdurent ou se séparent, et sur leurs enfants.