The precautionary principle is often invoked in relation to pregnant women and may be one of the underlying reasons for their continuous underrepresentation in clinical research. The principle is appealing, because potential fetal harm as a result of research participation is considered to be serious and irreversible. In our paper, we explore through conceptual analysis whether and if so how the precautionary principle should apply to pregnant women. We argue that the principle is a decision-making strategy underlying risk-benefit decisions in (...) clinical research, which can be applied to pregnant women. However, the current application is a strong one, leading to the promotion of absolute exclusion or, less often, absolute inclusion of pregnant women. In order to change this paralyzing situation, a shift toward weak precautionary thinking is necessary. Instead of automatic extreme precaution, a balance will be found between harms and potential benefits of including pregnant women in clinical research. (shrink)

In academic research, many attempts have been undertaken to legitimize corporate community involvement by showing a business case for it. However, much less attention has been devoted to building understanding about the actual dynamics and challenges of managing CCI in the business context. As an alternative to existing predominantly static and top-down approaches, this paper introduces a social movement framework for analyzing CCI management. Based on the analysis of qualitative case study data, we argue that the active role of employees (...) pressuring for CCI policies and practices, as well as the organization audience responses to their efforts, are at the core of the challenges involved in managing CCI. These challenges also pose limits to how far CCI can be extended to a “business as usual” activity. (shrink)

Spatial relations are central to geometrical thinking. With respect to the classical elementary geometry of Euclid’s Elements, a distinction between co-exact, or qualitative, and exact, or metric, spatial relations has recently been advanced as fundamental. We tested the universality of intuitions of these relations in a group of Senegalese and Dutch participants. Participants performed an odd-one-out task with stimuli that in all but one case display a particular spatial relation between geometric objects. As the exact/co-exact distinction is closely related to (...) Kosslyn’s categorical/coordinate distinction, a set of stimuli for testing all four types was used. Results suggest that intuitions of all spatial relations tested are universal. Yet, culture has an important effect on performance: Dutch participants outperformed Senegalese participants and stimulus layouts affect the categorical and coordinate processing in different ways for the two groups. Differences in level of education within the Senegalese participants did not affect performance. (shrink)

The purpose of this paper is to investigate the effect of intra-organizational networking on individual task performance, via employability. Moreover, this study also examines whether this relationship differs for younger (<40 years) versus older employees (≥40 years). A self-report questionnaire was distributed among a sample of employees working in a range of different types of organizations (n= 374). We conclude that employability fully mediates the relationship between intra-organizational networking and individual task performance. However, this mediation effect did not vary between (...) younger and older employees. This study extends past research by applying a human capital perspective (in particular, social capital) and life-span development frameworks for explaining employability and task performance enhancement across one’s working life. It provides useful insights for stimulating career development and individual performance growth, by means of social capital, herewith increasing the individual employee’s chance to survive in nowadays’ labor markets. (shrink)

Ausgehend von der, von Journalisten und Musikern immer wieder bemühten Metapher des 'Black CNN' wird versucht, das Potenzial der musikalischen Ausdrucksform des HipHop als Kommunikationsstruktur der Schwarzen Minderheit in den USA zu analysieren. Nach einer historisch-kulturellen Erläuterung, die sich mit der Tradition der Reflektion sozialer und politischer Aspekte in den unterschiedlichen musikalischen Äußerungen der Schwarzen Volksgruppe in den USA beschäftigt und schon ansatzweise die Bedeutung dieser Ausdrucksmöglichkeit im Kontext eines 'internal colonialsm' vor Augen führt, werden jene soziodemographischen Entwicklungen nachvollziehbar gemacht, (...) die sich als zentraler Kritikpunkt in den verbalen Artikulationen des HipHop widerspiegeln. Bestehende mediale Dysfunktionen hinsichtlich der Repräsentation von Angehörigen der Schwarzen Minderheit werden mit einem entsprechenden Fallbeispiel belegt. Vor dem theoretischem Hintergrund von 'cultural citizenship' - ein Konzept zur Bestimmung kultureller Teilhabe in der Mediengesellschaft -, werden 25 Textbeispiele, die sich auf HipHop-Veröffentlichungen von 1982 bis 2004 finden, auf ihre Übereinstimmung mit Indikatoren untersucht, die sich aus, den Medien zugeschriebenen, politischen und sozialen Funktionen ableiten lassen. Die angewandte Inhaltsanalyse lässt zahlreiche Entsprechungen erkennen, die sich zum Teil in komplexen, der Kritik- und Kontrollfunktion bzw. Integrationsfunktion der Medien zuzuordnenden Inhalten äußern. (shrink)

As early as 2002, CIOMS stated that pregnant women should be presumed eligible for participation in research. Despite this position and calls of other well‐recognized organizations, the health needs of pregnant women in research remain grossly under‐researched. Although the presumption of eligibility remains unchanged, the revision of the 2002 CIOMS International ethical guidelines for biomedical research involving human subjects involved a substantive rewrite of the guidance on research with pregnant women and related guidelines, such as those on fair inclusion and (...) vulnerability. However, close reading of the guidelines reveals morally relevant different approaches to fair inclusion of pregnant women and other under‐represented groups, such as children and incompetents. Where CIOMS sets out that children and adolescents must be included unless a good scientific reason justifies their exclusion, no such claim of having to justify exclusion appears in the guideline on pregnant women. Instead, CIOMS claims that research relevant to pregnant women’s health needs must be promoted. This paper analyses how and to what extent the guideline on pregnant women differs from other guidance on fair inclusion in the document. Accordingly, the paper evaluates to what extent the current phrasing may contribute to fair inclusion of pregnant women in research. We will conclude that a system change towards a learning health system is essential to break down the status quo of knowledge generation in the field of medication use during pregnancy and argue that the CIOMS guidelines allow for this system change. (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)

Until now, the short cult hymns to Liber, Mars and Juno in the Appendix Claudianea have mostly been seen as rhetorical school exercises. Yet a philological-historical analysis shows that they could be remains of occasional poetry from everyday life. The hymns are structured according to the Roman festival calendar and, on the basis of language and content, should probably be dated to the final phase of public non-Christian cult practice in the fourth century. The anonymous poet was familiar with classical (...) Greek and Latin poetry, but reveals weaknesses in Latin prosody and metre. It can therefore be supposed that he should be identified as one of the many Graeco-Egyptian ‘wandering poets’, but probably not as Claudian himself. (shrink)

The Western Tradition has long struggled to define and understand evil, yet definitive answers continue to elude us. So, too, the role of evil in Goethe's Faust remains problematic. With the help of Mephistopheles, Faust acquires a forbidden,,knowledge of good and evil“, evoking the biblical story of the Fall. This study uncovers important layers of meaning in that story and reveals its special and unrecognized significance for Faust.

Background: Self-determination is an important factor in improving the quality of life of people with moderate intellectual disabilities. A focus on self-determination implies that restraints on the freedom of people with intellectual disabilities should be decreased. In addition, according to the Dutch Care and Coercion bill, regular restraints of freedom, such as restrictions on choice of food or whom to visit, should be discouraged. Such restraints are only allowed if there is the threat of serious harm for the clients or (...) their surroundings. Research question: What do support staff consider as restraints on freedom and how do they justify these restraints? Research design: In this study, data were collected by semi-structured interviews. Participants and research context: Fifteen support staff working with clients with moderate intellectual disabilities were interviewed. All participants work within the same organisation for people with intellectual disabilities in the Eastern part of the Netherlands. Ethical considerations: The study was conducted according to good scientific inquiry guidelines and ethical approval was obtained from a university ethics committee. Findings: Most restraints of freedom were found to be centred around the basic elements in the life of the client, such as eating, drinking and sleeping. In justifying these restraints, support staff said that it was necessary to give clarity in what clients are supposed to do, to structure their life and to keep them from danger. Discussion: In the justification of restraints of freedom two ethical viewpoints, a principle-guided approach and an ethics of care approach, are opposing one other. Here, the self-determination theory can be helpful, while it combines the autonomy of the client, relatedness to others and the client’s competence. Conclusion: Despite the reasonable grounds support staff gave for restraining, it raises the question whether restraints of freedom are always in the interest of the client. (shrink)

BackgroundThere is ambiguity with regard to what counts as an acceptable level of risk in clinical research in pregnant women and there is no input from stakeholders relative to such research risks. The aim of our paper was to explore what stakeholders who are actively involved in the conduct of clinical research in pregnant women deem an acceptable level of risk for pregnant women in clinical research. Accordingly, we used the APOSTEL VI study, a low-risk obstetrical randomised controlled trial, as (...) a case-study.MethodsWe conducted a prospective qualitative study using 35 in-depth semi-structured interviews and one focus group. We interviewed healthcare professionals, Research Ethics Committee members and regulators who are actively involved in the conduct of clinical research in pregnant women, in addition to pregnant women recruited for the APOSTEL VI case-study in the Netherlands.ResultsThree themes characterise the way stakeholders view risks in clinical research in pregnant women in general. Additionally, one theme characterises the way healthcare professionals and pregnant women view risks with respect to the case-study specifically. First, ideas on what constitutes an acceptable level of risk in general ranged from a preference for zero risk for the foetus up to minimal risk. Second, the desirability of clinical research in pregnant women in general was questioned altogether. Third, stakeholders proposed to establish an upper limit of risk in potentially beneficial clinical research in pregnant women in order to protect the foetus and the pregnant woman from harm. Fourth and finally, the case-study illustrates that healthcare professionals’ individual perception of risk may influence recruitment.ConclusionsHealthcare professionals, RECs, regulators and pregnant women are all risk adverse in practice, possibly explaining the continuing underrepresentation of pregnant women in clinical research. Determining the acceptable levels of risk on a universal level alone is insufficient, because the individual perception of risk also influences behaviour towards pregnant women in clinical research. Therefore, bioethicists and researchers might be interested in changing the perception of risk, which could be achieved by education and awareness about the actual benefits and harms of inclusion and exclusion of pregnant women. (shrink)

M. Laura Gemelli Marciano ist Titularprofessorin für Klassische Philologie an der Universität Zürich.